Affiliation:
1. Department of Medicine, Rheumatology Unit, Hadassah Medical Center and Faculty of Medicine Hebrew University of Jerusalem Jerusalem Israel
2. Department of Diagnostic Radiology, Hadassah Medical Center and Faculty of Medicine Hebrew University of Jerusalem Jerusalem Israel
Abstract
AbstractWe report the case of a 65 year old female patient, presenting with a combination of bilateral hearing loss, otalgia, and hyperacusis. Pure tone audiometry revealed mixed bilateral hearing loss. Conventional cranial imaging tests failed to show a significant brain pathology, but fat‐suppressed T1‐weighted gadolinium‐enhanced magnetic resonance imaging scan displayed a diffuse infiltrative skull base process, extending from the nasopharynx to the jugular fossa, and encasing the internal carotid artery. The latter findings, besides elevated inflammatory markers and a positive perinuclear anti‐neutrophil cytoplasmic antibody (p‐ANCA) led to the diagnosis of ANCA‐associated vasculitis. Additional disease manifestations sequentially appeared, including a right peripheral nerve palsy, aortitis, hepatitis, peripheral neuropathy, and uveitis. Therapy with corticosteroids, azathioprine, and then cyclophosphamide brought no evident benefit, but rituximab led to impressive clinical and radiologic improvement.