265 Granulomatosis With Polyangiitis Manifesting as Acute Otitis Media: A Case Report and Review of Literature

Abstract

Abstract Granulomatosis with polyangiitis (GPA) is a rare necrotising vasculitis of unknown aetiology affecting small and medium-sized vessels of the upper respiratory tract, lungs, and other organs. It is the most common anti-neutrophil-cytoplasmic-antibody (ANCA) associated vasculitis disorder. While otologic manifestations are identified in up to 70% of cases, it is occasionally misdiagnosed in this cohort of patients. We present a case of GPA which initially manifested as isolated acute otitis media. A 52-year-old female with a history of type 2 diabetes presented with a 6-week history of bilateral otalgia, otorrhea, and hearing loss. She denied facial paresis, sensory deficit, arthralgia, myalgia, visual symptoms, rashes, or diarrhoea. Examination revealed a right tympanic membrane perforation and an erythematous left tympanic membrane. The patient was treated with different courses of oral and topical antibiotics for a diagnosis of otitis media with effusion, to no avail. Subsequent serum analysis revealed a C-ANCA pattern, in keeping with GPA. The patient is being treated accordingly and is making stable progress. Less commonly, GPA may manifest as isolated otolaryngologic symptoms as seen in this case. Mindfulness of this entity helps reduce the risk of irreversible organ damage and patient morbidity.