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Relapsing polychondritis presented as inner ear involvement
1Department of Otolaryngology, Kanazawa University School of Medicine, Japan.
Abstract:
We report a rare case of relapsing polychondritis with an initial symptom of inner ear involvement. This 53-year-old Japanese man experienced a hearing difficulty, tinnitus in both ears, and dizziness of sudden onset, but lacked auricular chondritis at that time, which is the most frequent finding in relapsing polychondritis. Thus it was difficult to reach a correct diagnosis. Steroid therapy, with oral prednisolone 15 mg daily, was effective. Almost two months after we began the steroid therapy, the patient complained of losing interest in his work and reported a hallucination vision on the TV screen, so the dose of prednisolone was decreased to 10 mg. The hallucinations then disappeared, but the serum level of C-reactive protein increased highly. To reduce the dose of prednisolone, we tried low-dose oral methotrexate. However, we had to discontinue it when the patient experienced severe vomiting and diarrhoea. As adjuvant therapy, we then administered Sho-saiko-to, Chinese herbal medicines with few side effects. Symptoms and laboratory abnormalities then improved markedly.
Insights
This case study highlights relapsing polychondritis presenting with inner ear symptoms. Early steroid treatment was effective, with Chinese herbal medicine successfully managing relapsing polychondritis.
Area of Science:
- Rheumatology
- Otolaryngology
- Internal Medicine
Background:
- Relapsing polychondritis is a rare multisystem inflammatory disease.
- Auricular chondritis is the most common initial symptom, but not always present.
- Diagnosis can be challenging with atypical presentations.
Observation:
- A 53-year-old Japanese man presented with sudden hearing loss, tinnitus, and dizziness.
- Initial symptoms lacked auricular chondritis, delaying diagnosis.
- Steroid therapy (prednisolone) was initiated and showed initial efficacy.
Findings:
- Prednisolone dose reduction led to increased C-reactive protein levels.
- Low-dose methotrexate was discontinued due to severe gastrointestinal side effects.
- Adjunctive therapy with Sho-saiko-to (a Chinese herbal medicine) resulted in marked improvement.
Implications:
- Inner ear involvement can be the initial presentation of relapsing polychondritis.
- Atypical presentations require careful diagnostic consideration.
- Chinese herbal medicine may offer a safe and effective adjunctive treatment option for relapsing polychondritis.