Okura Takafumi, Miyoshi Ken-ichi, Jotoku Masanori, Enomoto Daijiro, Irita Jun, Nagao Tomoaki, Ito Ryoji, Higaki Jitsuo
Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine, Japan.
Intern Med. 2011;50(16):1725-8. doi: 10.2169/internalmedicine.50.4953. Epub 2011 Aug 15.
A 70-year-old woman was admitted to our hospital because of sudden hearing loss. She was treated with intratympanic dexamethasone, but her hearing impairment progressed. After admission, she developed scleritis of her left eye. Laboratory findings included elevated white blood cell count and C-reactive protein level, microhematuria, and proteinuria. Serology was positive for myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA), but negative for proteinase 3 (PR3)-ANCA. Renal biopsy revealed a single glomerulus with extensive glomerular tuft necrosis, indicating necrotizing vasculitis. She was diagnosed with MPO-ANCA-associated polyangiitis. ANCA-related polyangiitis should be considered in the differential diagnosis of sudden deafness or scleritis.
一名70岁女性因突发听力丧失入住我院。她接受了鼓室内地塞米松治疗,但听力障碍仍进展。入院后,她出现了左眼巩膜炎。实验室检查结果包括白细胞计数和C反应蛋白水平升高、镜下血尿和蛋白尿。血清学检查髓过氧化物酶抗中性粒细胞胞浆抗体(MPO-ANCA)呈阳性,但蛋白酶3(PR3)-ANCA呈阴性。肾活检显示一个肾小球有广泛的肾小球毛细血管袢坏死,提示坏死性血管炎。她被诊断为MPO-ANCA相关性血管炎。在突发耳聋或巩膜炎的鉴别诊断中应考虑ANCA相关性血管炎。