Vol.98 No.6 contentsPRACTICA OTO-RHINO-LARYNGOLOGICA
Vol. 98 No. 6 June 2005
A Case of Suspected Wegener's Granulomatosis
Beginning with Repeated Attacks of Vertigo
Soichi Sunaga, Kishiko Sunami, Rie Tochino,
Hiroyoshi Iguchi, Hideo Yamane and Nobuo Negoro
(Osaka City University)
Mika Ohya
(Izumi City Hospital)
A 64-year-old woman consulted our hospital complaining of repeated attacks of vertigo over a six-year. We diagnosed granulomatous angiitis because P-ANCA titers were positive, CT and MRI examinations demonstrated granulation in the middle ear and histopathological study of the kidney demonstrated crescentic glomerulonephritis. We therefore administered the same treatment as for Wegener's granulomatosis but did not use immunosuppressive drugs.
Prior to treatment, the frequency of her vertigo attacks had gradually increased and mixed (conductive and sensorineural) hearing loss appeared. We considered these symptoms were mainly due to infection, which can trigger worsening of Wegener's granulomatosis. We therefore first administered antibiotics, then prednisolone (PSL) and sulfamethoxazole and trimethoprim (ST) complex drugs.
Cyclophosphamide (CY) was not used even though it has effects on autoimmune disease, since it may promote infectious disease.
In such patients, it is important to determine whether autoimmune disease should first be treated with PSL and CY or infection should first be treated with antibiotics.
Key words : Wegener's granulomatosis, vertigo attack, immunosuppressive drugs, infectious disease