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Kaczmarczyk MS, Jurkiewicz D, Niemczyk S, Rymarz A. Aural Manifestations of Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis-Diagnosis, Symptoms, Treatment. J Clin Med 2024; 13:4298. [PMID: 39124565 PMCID: PMC11312814 DOI: 10.3390/jcm13154298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/15/2024] [Accepted: 07/19/2024] [Indexed: 08/12/2024] Open
Abstract
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of vasculitis sharing a common pathophysiology, which affects small and medium blood vessels. There are three categories of AAV: granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA). As a systemic disease, AAV can affect basically every organ. The goal of this publication is to sum up and underline the problem of the aural manifestation of AAV; it details the definition of Otitis Media with Antineutrophil Cytoplasmic Antibody Associated Vasculitis (OMAAV) and allows for a better understanding of the specific tasks of medical professionals taking part in the diagnostic and therapeutic process. Among others, this publication is directed to otolaryngologists who may encounter patients with AAV and often are the first specialists who see patients with early symptoms of AAV. This publication presents brief characteristics of AAV, descriptions of aural manifestations and symptoms, differential diagnosis, and both pharmacological and surgical treatment options, based on current recommendations and information found in the literature and clinical databases.
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Affiliation(s)
- Michał S. Kaczmarczyk
- Department of Otolaryngology and Laryngological Oncology with Clinical Department of Craniofacial Surgery, Military Institute of Medicine—National Research Institute, Szaserów 128, 04-349 Warsaw, Poland; (M.S.K.); (D.J.)
| | - Dariusz Jurkiewicz
- Department of Otolaryngology and Laryngological Oncology with Clinical Department of Craniofacial Surgery, Military Institute of Medicine—National Research Institute, Szaserów 128, 04-349 Warsaw, Poland; (M.S.K.); (D.J.)
| | - Stanisław Niemczyk
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine—National Research Institute, Szaserów 128, 04-349 Warsaw, Poland;
| | - Aleksandra Rymarz
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine—National Research Institute, Szaserów 128, 04-349 Warsaw, Poland;
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Yun SY, Choi YJ, Chung SR, Suh CH, Kim SC, Lee JH, Baek JH. Image findings of anti-neutrophil cytoplasmic antibody-associated vasculitis involving the skull base. Clin Radiol 2023; 78:e568-e573. [PMID: 37164808 DOI: 10.1016/j.crad.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 02/02/2023] [Accepted: 04/05/2023] [Indexed: 05/12/2023]
Abstract
AIM To investigate computed tomography (CT) and magnetic resonance imaging (MRI) features of skull bases involving anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV). MATERIALS AND METHODS A retrospective review was undertaken to identify an institutional historical cohort of 17 patients with confirmed AAV who underwent CT or MRI and had skull base involvement between 2002 and 2021. Two radiologists reviewed the extent and features of the lesions, bone changes, and other MRI findings. RESULTS A total of 17 patients (12 men; mean age ± standard deviation, 46.5 ± 17.1 years) were selected. AAV presented as infiltrative lesions with involvement at various sites. Most cases involved the paranasal sinuses (PNS; 88%, 15/17), nasopharynx (88%, 15/17), pterygopalatine fossa (82%, 14/17), and parapharyngeal space (82%, 14/17), frequently accompanied by mucosal irregularity of the PNS and nasopharynx (71%, 12/17). Central skull base and temporal bone involvement were seen in 53% (9/17) and 38% (6/16) of cases, respectively. On T1-weighted imaging (WI) and T2WI MRI, all lesions (15/15) showed predominant signal iso-intensity to grey matter. CONCLUSIONS Although radiological findings of AAV are non-specific and skull base involvement is less common, AAV may be considered if infiltrative lesions predominantly involving the PNS, nasopharynx, pterygopalatine fossa, and parapharyngeal space with combined bone changes of skull base are seen.
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Affiliation(s)
- S Y Yun
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Radiology, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Y J Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - S R Chung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - C H Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S C Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J H Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J H Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Granulomatosis with polyangiitis diagnosed during the treatment of otitis media with prednisolone in a patient with anti-neutrophil cytoplasmic antibody-associated vasculitis: A case report. Respir Med Case Rep 2022; 40:101771. [DOI: 10.1016/j.rmcr.2022.101771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/06/2022] [Indexed: 11/11/2022] Open
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Badia RR, Hendricks AR, Perez CL, Sertich A, Ripley L. Unique Presentation of Microscopic Polyangiitis: Hearing and Vision Loss, Dysphagia, and Renal Dysfunction. Cureus 2021; 13:e14069. [PMID: 33903832 PMCID: PMC8062312 DOI: 10.7759/cureus.14069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Microscopic polyangiitis (MPA) is an autoimmune small-vessel vasculitis often positive for perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA), or anti-myeloperoxidase (MPO), that classically affects the lungs, kidneys, and skin. Several atypical presentations of MPA involving other organs have also been reported in the literature. We report a unique case of a patient who presented with rare presentations of MPA: hearing and vision loss, dysphagia, renal dysfunction. Despite the atypical nature of her symptoms, her p-ANCA serology was positive and kidney biopsy was consistent with MPA. Regardless of the bizarre nature of a patient’s symptoms, we highlight the importance of considering MPA as a differential diagnosis in the setting of positive p-ANCA serology.
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Affiliation(s)
- Rohit R Badia
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA
| | - Allen R Hendricks
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, USA
| | - Carlos L Perez
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, USA
| | - Anthony Sertich
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA
| | - Lindsay Ripley
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, USA
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Ushio Y, Wakiya R, Kato M, Kameda T, Nakashima S, Shimada H, Mansour MMF, Sugihara K, Miyashita T, Kadowaki N, Dobashi H. Two cases of refractory eosinophilic granulomatosis with polyangiitis wherein mepolizumab was effective against pulmonary and ear lesions. Mod Rheumatol Case Rep 2021; 5:327-332. [PMID: 33533698 DOI: 10.1080/24725625.2021.1881205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Recently, mepolizumab, an interleukin (IL)-5 inhibitor, has been indicated for the treatment of eosinophilic granulomatosis with polyangiitis (EGPA) refractory to standard therapies. However, no reports have compared the efficacy of mepolizumab according to symptoms and organ lesions. Herein, we report two cases in which mepolizumab was highly effective in the management of EGPA with lung lesions and otitis media refractory to treatment with multiple immunosuppressive agents. These two cases suggest that mepolizumab is effective in treating pulmonary and ear lesions in EGPA.
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Affiliation(s)
- Yusuke Ushio
- Department of Internal Medicine, Division of Haematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Risa Wakiya
- Department of Internal Medicine, Division of Haematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Mikiya Kato
- Department of Internal Medicine, Division of Haematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Tomohiro Kameda
- Department of Internal Medicine, Division of Haematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Shusaku Nakashima
- Department of Internal Medicine, Division of Haematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Hiromi Shimada
- Department of Internal Medicine, Division of Haematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Mai Mahmoud Fahmy Mansour
- Department of Internal Medicine, Division of Haematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Koichi Sugihara
- Department of Internal Medicine, Division of Haematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Takenori Miyashita
- Department of Otorhinolaryngology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Norimitsu Kadowaki
- Department of Internal Medicine, Division of Haematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Hiroaki Dobashi
- Department of Internal Medicine, Division of Haematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
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Harabuchi Y, Kishibe K, Tateyama K, Morita Y, Yoshida N, Okada M, Kunimoto Y, Watanabe T, Inagaki A, Yoshida T, Imaizumi M, Nakamura T, Matsunobu T, Kobayashi S, Iino Y, Murakami S, Takahashi H, Tono T. Clinical characteristics, the diagnostic criteria and management recommendation of otitis media with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV) proposed by Japan Otological Society. Auris Nasus Larynx 2020; 48:2-14. [PMID: 32768313 DOI: 10.1016/j.anl.2020.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 02/06/2023]
Abstract
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a form of necrotizing vasculitis with few or no immune deposits. It primarily affects small and medium blood vessels. AAV is classified into three categories, granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangitis (EGPA), and two major ANCAs, proteinase 3 (PR3)-ANCA or myeloperoxidase (MPO)-ANCA are involved in their pathogenesis. Intractable otitis media frequently occurs in patients with GPA, MPA or EGPA, although all patients show similar clinical features, regardless of the type of AAV. Furthermore, approximately 15% patients with otitis media caused by AAV do not show ANCA positivity, histopathological evidence, or any other AAV-related lesions at the initial visit; therefore, these patients do not fulfill the ordinary diagnostic criteria for systemic AAV. Thus, we first proposed that this condition could be categorized as "otitis media with AAV (OMAAV)". Subsequently, the Japanese Otological Society (JOS) conducted a nationwide survey between December 2013 and February 2014 and identified 297 patients with OMAAV. The survey revealed that OMAAV is a disease that initially occurs in the middle ear and subsequently spreads to other organs such as the lungs and kidneys, with eventual involvement of all body organs. Severe sequelae such as facial palsy, hypertrophic pachymeningitis, complete deafness, and subarachnoid hemorrhage resulting in death can also occur. In this review, we introduce the clinical features, diagnostic criteria, and treatment strategies recommended by JOS for early diagnosis and treatment of OMAAV.
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Affiliation(s)
- Yasuaki Harabuchi
- Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, , Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510 Hokkaido, Japan.
| | - Kan Kishibe
- Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, , Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510 Hokkaido, Japan
| | - Kaori Tateyama
- Department of Otolaryngology, Oita University Faculty of Medicine, Oita, Japan
| | - Yuka Morita
- Department of Otolaryngology, Niigata University Faculty of Medicine, Niigata, Japan
| | - Naohiro Yoshida
- Department of Otolaryngology, Jichi Medical University Saitama Medical Center, Omiya, Japan
| | - Masahiro Okada
- Department of Otolaryngology, Ehime University Faculty of Medicine, Toon, Japan
| | - Yasuomi Kunimoto
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Takeshi Watanabe
- Department of Otolaryngology, Nagasaki University Faculty of Medicine, Nagasaki, Japan
| | - Akira Inagaki
- Department of Neuro-otolaryngology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tadao Yoshida
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsuyoshi Imaizumi
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
| | - Takeshi Nakamura
- Department of Otolaryngology, Miyazaki University Faculty of Medicine, Miyazaki, Japan
| | | | - Shigeto Kobayashi
- Department of Internal Medicine, Juntendo University Koshigaya Hospital, Koshigaya, Japan
| | - Yukiko Iino
- Department of Otolaryngology, Jichi Medical University Saitama Medical Center, Omiya, Japan
| | - Shingo Murakami
- Department of Neuro-otolaryngology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Haruo Takahashi
- Department of Otolaryngology, Nagasaki University Faculty of Medicine, Nagasaki, Japan
| | - Tetsuya Tono
- Department of Otolaryngology, Miyazaki University Faculty of Medicine, Miyazaki, Japan
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