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[A case of microscopic polyangitis accompanied by hearing loss as the initial sign of the disease]
Abstract:
Here we report a case of microscopic polyangitis (MPA) with anti-neutrophil cytoplasmic antibodies against myeloperoxidase (MPO-ANCA) accompanied by perceptive dominant hearing loss as the initial sign of the disease. A 52-year-old woman was admitted to Tokyo Metropolitan Ohtsuka Hospital in April 1996 because of bilateral progressive hearing loss. On admission, she had presented bilateral perceptive hearing loss, fever, myalgia, and weight loss. Laboratory data showed accelerated erythrocyte sedimentation rate, proteinuria, microscopic hematuria, leukocytosis, hypoproteinemia, and elevated creatinine level. Serum level of MPO-ANCA was elevated. Chest X-ray and computed tomography showed mild pleural effusion and interstitial shadow in bilateral lung fields. The biopsy findings detected that focal glomerulonephritis, and necrotizing angitis of small artery in kidney. The diagnosis of MPA was made with clinical course, laboratory findings, radiographic findings, and biopsy finding. Treatment was initiated with 45 mg of prednisolone, followed by marked improvement of hearing loss and decreased titer of serum MPO-ANCA. There are only seven reports showing hearing loss as the initial sign of the disease occurred in polyarteritis nodosa and MPA. The present case suggests the possibility that hearing loss may be the symptom of MPO-ANCA associated vasculitis.
Insights
Microscopic polyangitis (MPA) can initially present with hearing loss. This case highlights MPO-ANCA associated vasculitis presenting as perceptive hearing loss, responding well to prednisolone treatment.
Area of Science:
- Nephrology
- Rheumatology
- Otolaryngology
Background:
- Microscopic polyangitis (MPA) is a rare autoimmune disease characterized by inflammation of small blood vessels.
- Anti-neutrophil cytoplasmic antibodies (ANCA), particularly against myeloperoxidase (MPO-ANCA), are key diagnostic markers.
- MPA commonly affects the kidneys and lungs, but other organ systems can be involved.
Observation:
- A 52-year-old woman presented with bilateral perceptive hearing loss as the primary symptom.
- Accompanying symptoms included fever, myalgia, weight loss, and abnormal laboratory findings suggestive of systemic inflammation and kidney involvement.
- Radiographic and biopsy results confirmed focal glomerulonephritis and necrotizing angitis, consistent with MPA.
Findings:
- Elevated serum MPO-ANCA levels were detected.
- The patient experienced marked improvement in hearing loss and a decrease in MPO-ANCA titers following prednisolone treatment.
- This case adds to the limited reports of hearing loss as an initial manifestation of MPA.
Implications:
- Hearing loss may be an underrecognized initial symptom of MPO-ANCA associated vasculitis.
- Early diagnosis and treatment of MPA are crucial for preventing irreversible organ damage.
- This case underscores the importance of considering systemic vasculitis in patients presenting with unexplained hearing loss and systemic symptoms.