顔面神経麻痺を来したMPO―ANCA 陽性の中耳炎2症例

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1 11367 : MPOANCA MPO ANCA MPOANCA 134EU MPO ANCA 67EU MPOANCA ANCA : MPOANCAANCA antineutrophil cytoplasmic antibody ; ANCA Davies IgG ANCA PR3proteinase3ANCA MPOmyeloperoxidaseANCA Wegener PR3ANCA MPO ANCA : : : : : : 467dB 67dB 350dB 10dBCT : : C1 1000mg/ 30mg/ HSVVZV MRI

2 11368 MPOANCA A coagulase negative Staphylococcus Corynebacterium ANCA PR3ANCA MPOANCA 134EU/ml MPOANCA ; :MPOANCA 134 EU/mlPR3ANCA CH50 69U/mlCRP 294 mg/dl 7290/mm : leukocytoclastic vasculitis CT : : MPOANCA 30mg/ 50mg/ 72dB 73dB 43dB 22dB 53dB 40dB : : : : PR3ANCA MPOANCA 67EU/ml : : 108dB

3 1A CT 1B HE

4 2A CT 2B HE

5 MPOANCA B : : MPOANCA 58EU/mlPR3ANCA CH U/mlCRP 071mg/dl 6810/mm CT : CT : ANCA : leukocytoclastic vasculitis : MPOANCA 30mg/ 50mg/ MPOANCA 52dB 27dB PR3ANCA Wegener Wegener MPOANCA MPO ANCA

6 11370 MPOANCA MPOANCA MPOANCA EU/ml WG Akahoshi et al. WG WG ANCA positive ANCA ANCA ANCA WG : Wegener MPOANCA ANCA MRI Cogan Cogan ANCA MPO ANCA ANCA ANCA CRP CD20 Rituximab Wegener MPOANCA ANCA ANCA

7 MPOANCA ANCA Davies DJ, Moran JE, Niall JF, et al : Segmental necrotising glomerulonephritis with antineutrophil antibody : possible arbovirus aetiology? Br Med JClin Res Ed 1982 ; 285 : 606. Akahoshi M, Yishimoto G, Nakashima H, et al : MPO ANCA positive Wegener s granulomatosis presenting with hypertrophic cranial pachymeningitis : case report and review of the literature. Mod Rheumatol 2004 ; 14 : Sugiyama Y, Shimizu M, Hoshi A, et al : An old man presenting with fluctuating bilateral multiple cranial nerve palsies and positive test for perinuclear antineutrophil cytoplasmic antibody. No To Shinkei 1999 ; 51 : ,,, :. ; :.,,, :MPOANCA. ; :.,,, : Wegener. ; :.,,, :MPOANCA. ; :.,,, :. ; :. Brunner J, Freund M, Prelog M, et al : Successful treatment of severe juvenile microscopic polyangitis with rituximab. Clin Rheumatol 2009 ; Apr 24. Epub ahead of print Yoon TH, Paparella MM, Schachern PA : Systemic vascullitis : a temporal bone histopathologic study. Laryngoscope 1989 ; 99 : Two Cases of MPOANCApositive Otitis Media Associated with Facial Palsy Hajime Usubuchi, M.D., Kozue Kodama, M.D., Katsumi Takizawa, M.D. Takeharu Kanazawa, M.D., Yasushi Ohta, M.D., Keiko Kakizaki, M.D. and Yukiko Iino, M.D. Jichi Medical University Saitama Medical Center, Saitama Kakizaki ENT Clinic, Kazo We report two cases of otitis media positive for antimyeloperoxidase antineutrophil cytoplasmic antibodympo ANCAassociated with facial palsy. Case 1 : A 73yearold man treated for 3 months for bilateral otitis media with effusion had left facial nerve palsy and deteriorated bone conduction hearing in both ears. Blood analysis showed elevated MPOANCA to 134 EU. Case 2 : A 66yearold woman treated for about one year for bilateral otitis media with effusion and fluctuating mixed hearing loss had bilateral facial nerve palsy and a blood test positive for MPOANCA at 67 EU. Both were diagnosed with otitis media caused by ANCArelated vasculitis. After prednisolone and cyclophosphamide administration for half a year, blood test results were negative for MPOANCA. Both recovered almost completely from facial nerve palsy and bone conductive hearing loss partially improved except in one hearingimpaired ear. ANCArelated vasculitis of the temporal bone should thus be considered in those with intractable otitis media and deteriorated bone conduction hearing before the occurrence of facial palsy. Keywords : MPOANCA, ANCArelated vasculitis, facial nerve palsy, otitis media, progressive sensorineural hearing loss Nippon Jibiinkoka Gakkai KaihoTokyo113 : 6771, 2010

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