Ekvivalent: Obostrana paraliza ličnog živca kao početni simptom granulomatoznog poliangitisa – prikaz slučaja

professional thesis

• Title (english): Equivalent: Bilateral paralysis of the facial nerve as a first symptom of granulomatous polyangiitis – a case report
• Author: Zrinka Ćustić
• Mentor: Jakov Ajduk (mentor)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2024-12-18, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Otorhinolaryngology

Abstract

Uvod: Granulomatozni poliangitis, poznatiji pod ranije korištenim nazivom Wegenerova granulomatoza, rijetka je bolest karakterizirana nekrotizirajućim vaskulitisom koji zahvaća male arterije i vene, te dovodi do stvaranja granuloma. Simptomi ovise o zahvaćenim organima, a najčešće je riječ o gornjim i donjim dišnim putovima, te bubrezima. Obostrana akutna upala srednjeg uha, uz obostranu parezu ličnog živca, izrazito je rijedak prvi simptom granulomatoznog poliangitisa. Pregledom literature na engleskom jeziku uspjeli smo naći desetak do sada opisanih slučajeva.

Prikaz slučaja: U slučaju naše bolesnice radi se o iznimno rijetkim prvim simptomima granulomatoznog poliangitisa. Riječ je o tridesetrogodišnjoj bolesnici, bez ranije poznatih sistemskih bolesti, koja se inicijalno javila otorinolaringologu zbog akutne upale oba uha, praćene parezom ličnog živca na desnom uhu. Usprkos provedenom liječenju, koje je uključivalo obostranu miringotomiju i sistemsku antibiotsku i kortikosteroidnu terapiju, došlo je do pogoršanja upale lijevog uha, uz razvoj pareze ličnog živca i s te strane. Radiološkom obradom (CT, MR) nije nađen lokalni uzrok pogoršanja bolesti, te je učinjena daljnja obrada. Nađene su povišene vrijednosti ANCA-e, a naknadnom imunološkom obradom potvrđena je dijagnoza granulomatoznog poliangitisa.

Zaključak: Pareza ličnog živca uzrokovana akutnom upalom uha izrazito je rijetko prvi simptom granulomatoznog poliangitisa, no ovu bolest treba uzeti u obzir u diferencijalnoj dijagnostici kod bolesnika bez odgovarajućeg poboljšanja na liječenje.

Abstract (english)

Introduction: Granulomatous polyangiitis, formerly known as Wegener granulomatosis, is a rare disease characterized by necrotizing vasculitis that affects small arteries and veins and leads to the formation of granulomas. Symptoms depend on organs affected. Upper and lower respiratory tract and kidneys are the most common sites. Bilateral acute otitis media with bilateral paresis of the facial nerve is an extremely rare first symptom of granulomatous polyangiitis.

Case report: We describe a case of a thirty-three-year-old patient, with no previous known systemic diseases, who initially attended an otorhinolaryngologist due to acute inflammation of both ears accompanied with paresis of the facial nerve on the right ear. Myringotomy was performed on both ears and the patient received a parenteral antibiotic and corticosteroid therapy. Despite the treatment, the deterioration of the inflammation on the left ear occurred, also with the development of paresis of the facial nerve on the left side. The radiological examination (CT, MR) did not find a local cause that would explain such a severe inflammation. Elevated ANCA values were found, and further testing confirmed the diagnose of
granulomatous polyangiitis.

Conclusion: Bilateral paresis of the facial nerve caused by acute otitis media is an extremely rare first symptom of granulomatous polyangitis but this disease should be considered in the differential diagnosis of these patients.

• Keywords: granulomatozni poliangitis; lični živac; upala uha
• Keywords (english): granulomatous polyangitis; facial nerve; ear infection
• Language: croatian
• URN:NBN: urn:nbn:hr:105:363106
• Study programme: Title: Otorhinolaryngology; Study programme type: university; Study level: postgraduate specialist; Academic / professional title: sveučilišni/a magistar/magistra otorinolaringologije (sveučilišni/a magistar/magistra otorinolaringologije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2025-02-18 09:14:20