Wegener’s granulomatosis: diagnostic dilemma

Abstract

Wegener's granulomatosis is a systemic disease characterized by a granulomatous lesion that can affect any organ throughout the body. This case-report illustrates the problem posed by a patient presenting with bilateral serous otitis media with marked sensorineural hearing loss, facial nerve paralysis and an atypical serological picture. The importance of early diagnosis and the protocol for the management of a patient with an uncertain diagnosis is discussed. Due to atypical presentations, only a high index of suspicion will ensure an early diagnosis.

Otologic Symptoms as Initial Manifestation of Wegener Granulomatosis

“…Chronic otitis media is caused by direct middle ear or mastoid cavity involvement by granulomatous process. Case of patient presenting with middle ear effusion and conductive hypoacusis later progressing to mixed type hearing loss was described by Banerjee et al (12). Purulent otitis media in the series of 10 patients was published by Illum and Thorling (10); in 7, it was the initial sign: 1 patient showed permanent minor perforations of the drum, and the other 6 had otitis media of a different and clinically far more violent course, accompanied by cranial nerve palsy (10).…”

Wegener granulomatosis in parotid fistula and bilateral nasal mass

“…[1] As in our case, when the patient consults with limited symptoms of WG and rare organ involvement (like the parotid gland), it is important to have a high index of suspicion. [16] For this reason, ENT doctors should not overlook WG in the differential diagnosis of patients with chronic inflammation and head and neck region involvement that is non responsive to medical therapy.…”

Imagerie des atteintes ORL et cérébrales de la granulomatose de Wegener

“…Le patient a géné-ralement une rhinite et une épistaxis. Cette absence de spéci-ficité est très souvent à l'origine d'un retard de prise en charge et d'un pronostic péjoratif [2]. L'imagerie est un des éléments qui permet de réduire ce délai, d'instaurer un traitement adapté, afin d'améliorer le pronostic du patient [3].…”