Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-27T10:26:12.028Z Has data issue: false hasContentIssue false
  • English
  • Français

Wegener's granulomatosis mimicking skull base osteomyelitis

Published online by Cambridge University Press:  16 August 2011

A Sharma ,
S Deshmukh ,
A Shaikh  and
J Dabholkar
A Sharma*
Affiliation:
Department of Otorhinolaryngology and Head-Neck Services, Seth G S Medical College, King Edward VII Memorial Hospital, Mumbai, India
S Deshmukh
Affiliation:
Department of Otorhinolaryngology and Head-Neck Services, Seth G S Medical College, King Edward VII Memorial Hospital, Mumbai, India
A Shaikh
Affiliation:
Department of Otorhinolaryngology and Head-Neck Services, Seth G S Medical College, King Edward VII Memorial Hospital, Mumbai, India
J Dabholkar
Affiliation:
Department of Otorhinolaryngology and Head-Neck Services, Seth G S Medical College, King Edward VII Memorial Hospital, Mumbai, India
*
Address for correspondence: Dr Arpit Sharma, Assistant Professor, Department Of Otorhinolaryngology and Head-Neck Services, Seth G S Medical College, KEM Hospital, Parel, Mumbai 400012, India E-mail: dr_arpit_sharma@hotmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To report a case of Wegener's granulomatosis mimicking skull base osteomyelitis.

Case report:

A case of Wegener's granulomatosis is reported in a diabetic woman presenting with facial palsy and hearing loss. The clinical course of the disease was very similar to that of skull base osteomyelitis, especially since the patient was diabetic and the ear swab was positive for pseudomonas. The definitive diagnosis was made based on clinical presentation, imaging and serum antineutrophil cytoplasmic antibody testing. The patient was started on immunosuppressants, and her hearing loss and facial palsy recovered.

Conclusion:

Wegener's granulomatosis is a systemic disease with various manifestations. A high index of clinical suspicion is required to reach the correct diagnosis. The clinician should be alerted to the possibility of Wegener's granulomatosis in the presence of: systemic upset out of proportion to the apparent intensity of the local lesion; middle-ear disease failing to respond to conventional treatment; and a consistently raised erythrocyte sedimentation rate.

Keywords

Wegener's GranulomatosisOtitis ExternaOsteomyelitisAntibodiesAntineutrophil CytoplasmicHearing LossFacial Palsy
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 2 , February 2012 , pp. 203 - 206
Copyright
Copyright © JLO (1984) Limited 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Srouji, IA, Andrews, P, Edwards, C, Lund, VJ. Patterns of presentation and diagnosis of patients with Wegener's granulomatosis: ENT aspects. J Laryngol Otol 2007;121:653–8CrossRefGoogle ScholarPubMed
2Lloyd, G, Lund, VJ, Beale, T, Howard, D. Rhinologic changes in Wegener's granulomatosis. J Laryngol Otol 2002;116:565–9CrossRefGoogle ScholarPubMed
3Nikolaou, AC, Vlachtsis, K, Daniilidis, M, Petridis, DG, Daniilidis, IC. Wegener's granulomatosis presenting with bilateral facial nerve palsy. Eur Arch Otorhinolaryngol 2001;258:198–202CrossRefGoogle ScholarPubMed
4Illum, P, Thorling, K. Otological manifestations of Wegener's granulomatosis. Laryngoscope 1982;9:801–4CrossRefGoogle Scholar
5Macias, JD, Wackym, PA, McCabe, BF. Early diagnosis of otologic Wegener's granulomatosis using the serologic c-ANCA. Ann Otol Rhinol Laryngol 1993;102:337–41CrossRefGoogle ScholarPubMed
6Banerjee, A, Armas, JM, Dempster, JH. Wegener's granulomatosis: diagnostic dilemma. J Laryngol Otol 2001;115:46–7CrossRefGoogle ScholarPubMed
7Carrie, S, Hughes, KB, Watson, MA. Negative ANCA in Wegener's granulomatosis. J Laryngol Otol 1994;108:420–2CrossRefGoogle ScholarPubMed
8Schonermarck, U, Lamprecht, P, Csernok, E, Gross, WL. Prevalence and spectrum of rheumatic diseases associated with proteinase 3-antineutrophil cytoplasmic antibodies (ANCA) and myeloperoxidase-ANCA. Rheumatology (Oxford) 2001;40:178–84CrossRefGoogle ScholarPubMed
9Bradley, PJ. Wegener's granulomatosis of the ear. J Laryngol Otol 1983;97:623–6CrossRefGoogle ScholarPubMed
10Bibas, A, Fahy, C, Sneddon, L, Bowdler, D. Facial paralysis in Wegener's granulomatosis of the middle ear. J Laryngol Otol 2001;115:304–6CrossRefGoogle ScholarPubMed