Tsunoda K, Akaogi J, Ohya N, Murofushi T
Department of Otolaryngology, Nissan Tamagawa Hospital, Tokyo, Japan.
J Laryngol Otol. 2001 Apr;115(4):311-2. doi: 10.1258/0022215011907271.
A 74-year-old male was referred for the sudden onset of bilateral sudden deafness. The patient had no history of any disease or trauma to the head. Pure tone audiometry revealed bilateral moderate, to severe, sensorineural hearing loss. Auditory brain stem responses (ABRs) showed normal peak and interpeak latencies. These audiological findings suggested that his hearing loss could be attributed to inner ear lesions. However, we felt an alternative explanation for this sudden deafness was likely to exist because the patient also had a month-long fever of unknown origin (FUO) and weight loss of 5 kg/month. Using the criteria of The American College of Rheumatology, we made the diagnosis of polyarteritis nodosa (PAN). Serum MPO-ANCA was positive (x 661). For treatment, the patient was begun on prednisolone and cyclophosphamide. Nine months later, fever, hypertension, nephritis, pneumonitis, and arthritis had completely resolved, the MPO-ANCA became negative (MPO-ANCA < x 10). Furthermore, his hearing improved.
一名74岁男性因突发双侧突发性耳聋前来就诊。该患者无任何疾病史或头部外伤史。纯音听力测定显示双侧中度至重度感音神经性听力损失。听性脑干反应（ABR）显示峰潜伏期和峰间潜伏期正常。这些听力学检查结果表明，他的听力损失可能归因于内耳病变。然而，我们认为这种突发性耳聋可能存在另一种解释，因为该患者还持续发热一个月且病因不明（不明原因发热），每月体重减轻5千克。根据美国风湿病学会的标准，我们诊断为结节性多动脉炎（PAN）。血清髓过氧化物酶抗中性粒细胞胞浆抗体（MPO-ANCA）呈阳性（x 661）。治疗方面，患者开始使用泼尼松龙和环磷酰胺。九个月后，发热、高血压、肾炎、肺炎和关节炎完全消退，MPO-ANCA转为阴性（MPO-ANCA < x 10）。此外，他的听力有所改善。
