Unusual Presentation of Granulomatosis With Polyangitis (Wegener's Granulomatosis)

Objective: To present a case of unusual presentations of granulomatosis with polyangitis (Wegener’s granulomatosis) with parotid swelling and intractable otitis externa. Material and method: A 22-year-old male patient presented with left sided otitis externa with left sided parotid swelling and bilateral nasal obstruction for last two weeks. CT scan of paranasal sinuses showed homogenous mass in both maxillary antra and nasal cavities. FNAC from the parotid swelling was suggestive of granulomatous disease and endoscopic biopsy from the nasal mass showed features of granulomatosis with polyangitis (Wegener’s granulomatosis). CT scan of chest revealed multiple cysts within the lung parenchyma; urine examination showed RBC and pus cells. Renal biopsy showed focal segmental glomerulonephritis. c-ANCA was highly positive and thus the diagnosis of Wegener’s granulomatosis was made. Result: Patient received cyclophosphamide and prednisolone immunsuppressive therapy for one year, which showed marked clinical improvement. Conclusion: Granulomatosis with polyangitis (Wegener’s granulomatosis) is not an uncommon entity for otolarygologists. Its usual presentation mimics chronic rhinosinusitis; but presentations like otitis externa and parotid swelling are rare for this disease.

Bacteriology of Chronic Maxillary Sinusitis in Relation to Sinoscopic Appearance

Background The bacteriology of chronic maxillary sinusitis in relation to different sinoscopic appearances is reported in this study. Methods When transantral sinoscopy via an anterior wall puncture was used to examine the maxillary antra in patients with chronic maxillary sinusitis, the sinoscopic appearances were divided into five types. Maxillary antra in which ostia were recognized under the endoscope and no secretion existed were classified as type 1. Maxillary antra in which ostia were not recognized and no secretion existed belonged to type 2. Maxillary antra in which seromucoid secretion existed belonged to type 3. Maxillary antra in which mucopurulent discharge existed belonged to type 4. Maxillary antra in which fungal balls existed belonged to type 5. Swab specimens of these antra were sent for aerobic and anaerobic cultures. Results Between 1988 and 1998, 493 sinoscopic appearances of maxillary antra were classified. Among them, 72 were classified as type 1, 59 were type 2, 75 as type3, 227 were type 4, and 60 were type 5. The culture rate of swab specimens from those antra with type 1 sinoscopic appearance was 56.9%. The culture rates were 59.3% for type 2, 48% for type 3, 64.8% for type 4, and 88.3% for type 5. Common cultured bacteria were similar among antra with different types of sinoscopic appearances, except type 5 antra, but less gram-negative aerobes grew from type 1 antra. Conclusions This study shows that the bacteriology of noninvasive fungal sinusitis was different from that of ordinary chronic maxillary sinusitis. However, among ordinary chronic maxillary sinusitis, the bacteriology was similar between maxillary antra with different sinoscopic appearances except with mild disease.