A case of polyarteritis nodosa initiated by serous otitis media and scleritis

A case of polyarteritis nodosa (PAN), in which serous otitis media and scleritis were the initial signs, is reported. 61-year old woman suddenly complained of vertigo and hearing impairment. Diagnosis of serous otitis media was done and she developed the same symptoms several times later. Six months after the first manifestations of aural symptoms, she developed painful red eyes bilaterally and a diagnosis of scleritis was made. Treatment with betamethasone and atropine eye drop was started. During a year of follow-up, a deterioration of her hearing impairment, which was mixture of conductive and perceptive loss, occured. From these findings, atypical Cogan's syndrome was considered though definite diagnosis could not be made for lack of informations around the onset of her illness. About one and a half years' of her illness, she developed fever, consciousness disturbance and deterioration of ocular symptoms occured, however the involvement of other organs was not apparent. Tentative diagnosis of a “systemic vasculitis” was made. She was treated with oral predonisone 40 mg daily, with improvement in her general condition but without beneficial effect on hearing acuity. Later muscle biopsy was performed and a specimen revealed necrotizing vasculitis. A diagnosis of PAN was made. Our case seems to be important in considering the correlation between PAN and atypical Cogan's syndrome.