好酸球性多発血管炎性肉芽腫症の耳科学的臨床像―好酸球性中耳炎との比較において  [in Japanese] A Case of Eosinophilic Granulomatosis with Polyangiitis Associated with Posterior Auricular Arteritis  [in Japanese]

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Author(s)

    • 大庭 聖也 Oba Seiya
    • 東京医科歯科大学 膠原病・リウマチ内科 Department of Rheumatology, Tokyo Medical and Dental University
    • 真壁 彩音 Makabe Ayane
    • 東京医科歯科大学 耳鼻咽喉科 Department of Otorhinolaryngology, Tokyo Medical and Dental University
    • 伊藤 卓 Ito Taku
    • 東京医科歯科大学 耳鼻咽喉科 Department of Otorhinolaryngology, Tokyo Medical and Dental University
    • 堤 剛 Tsutsumi Takeshi
    • 東京医科歯科大学 耳鼻咽喉科 Department of Otorhinolaryngology, Tokyo Medical and Dental University

Abstract

<p>好酸球性多発血管炎性肉芽腫症(EGPA)は初期において耳症状が主症状であることが多い.今回我々はEGPAの臨床像を明らかにするために,耳症状を主症状とするEGPAの一症例を呈示し,さらに自験例のEGPAと好酸球性中耳炎の臨床所見を比較した.EGPAに特徴的な耳内所見はツチ骨周囲と外耳道後壁の肉芽性炎症であり,造影3次元T1強調画像(3D-SPGR法)から示唆された後耳介動脈炎との関連が考えられた.他方,合併する難聴やめまいは別の血管炎の存在も考えられた.また好酸球増多症や末梢神経障害,顔面神経麻痺はEGPAに特徴的な臨床所見であった.これらの所見を認めた場合は積極的な全身検索を行うことがEGPAの早期診断につながると考えられる.</p>

<p>Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic vasculitis affecting small-sized vessels of the lungs and nervous system. However, otologic presentations are often dominant early in the course of EGPA, making it difficult to differentiate EGPA from eosinophilic otitis media (EOM). Here we demonstrate a case of EGPA showing otitis media as the major symptom, and statistically compare clinical profiles of EGPA and EOM. Results revealed that the most typical otologic manifestation of EGPA is chronic otitis with granulating inflammation mainly affecting the posterior part of the meatus and ear drum. Gadolinium-enhanced 3D fast spoiled gradient-recalled imaging indicated the presence of posterior auricular arteritis as a potential etiology of granulomatous otitis of EGPA. However, vestibular examinations, including vestibular evoked myogenic potential, indicated the involvement of other vessels in the inner ear. Unlike EOM, peripheral neuropathy, facial nerve paresis and eosinophilia were specific to EGPA.</p>

Journal

  • Otology Japan

    Otology Japan 29(1), 45-51, 2019

    Japan Otological Society

Keywords

Codes

  • NII Article ID (NAID)
    130007695452
  • Text Lang
    JPN
  • ISSN
    0917-2025
  • Data Source
    J-STAGE 
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