Otitis media with antineutrophil cytoplasmic antibody-associated vasculitis caused by Eustachian tube inflammation

AbstractA 78-year-old woman with a 9-year history of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis presented with malaise and loss of appetite for one month. Laboratory tests showed an increased serum C-reactive protein level and a high titer of serum myeloperoxidase-specific ANCA. Computed tomography (CT) scan showed thickening of the mucosa of the left Eustachian tube. Although she did not complain of difficulty in hearing, results of audiometry showed left conductive hearing loss. She was diagnosed to have otitis media. The otitis media did not respond to antibiotics. For further evaluation of the Eustachian tube lesion, we performed magnetic resonance imaging (MRI), which revealed abnormal enhancement and swelling of the left Eustachian tube; this suggested that there was an obstruction of the Eustachian tube. Following the diagnosis of otitis media with ANCA-associated vasculitis (OMAAV), treatment with prednisolone and rituximab was administered. She responded well to the treatmen...