The First Case of Vestibulocochlear Neuritis in a Patient with … · 2016-07-11 · suggested neuropathies of the central auditory and vestibular regions [7]. In the vestibular function
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Infection & Chemotherapy
Received: August 4, 2014 Revised: November 18, 2014 Accepted: November 19, 2014 Corresponding Author : Hee Jung Yoon, MD, Ph.D. Division of Infectious Diseases, Seoul Metropolitan Government Seobuk Hospital, 49 Galhyeonro 7-gil, Eunpyeong-gu, Seoul 03433, KoreaTel: +82-42-611-3096, Fax: +82-42-611-3853E-mail: [email protected]
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The First Case of Vestibulocochlear Neuritis in a Patient with Acquired Immunodeficiency Syndrome in KoreaHyun Joo Park1, Chin Saeng Cho2, Nak Min Kim1, Su A Yun1, and Hee Jung Yoon3
1Division of Infectious Diseases, Department of Internal Medicine, Eulji University Hospital; 2Department of Otorhinolaryngology, Eulji University Hospital, Daejeon; 3Division of Infectious Diseases, Seoul Metropolitan Government Seobuk Hospital, Seoul, Korea
The incidence of human immunodeficiency virus (HIV) infections continue to increase throughout the world. Although neu-rologic complications are frequent in individuals with HIV infection or acquired immunodeficiency syndrome (AIDS), vestib-ulocochlear neuritis is still a relatively rare manifestation. We report the first case of vestibulocochlear neuritis occurring in an AIDS patient in Korea.
Key Words: Vestibulocochlear nerve diseases; Human immunodeficiency virus; Hearing loss
Introduction
Worldwide, the incidence and prevalence of acquired im-
munodeficiency syndrome (AIDS) are on the rise. Neurologic
manifestations are particularly common in individuals with
AIDS, and ear, nose, and throat manifestations are frequently
the earliest symptoms of immunodeficiency. Such manifesta-
tions are caused either by human immunodeficiency virus
(HIV) itself or by opportunistic infections. However, sudden
sensorineural hearing loss (SSHL) due to vestibulocochlear
neuritis has rarely been reported [1]. In the literature, there
are a few case reports describing vestibulocochlear neuritis in
patients with AIDS, including two cases associated with HIV
seroconversion syndrome [1, 2], one case due to cerebral lym-
phocytic infiltration [3], two cases caused by cytomegalovirus
(CMV) infection [4], and two cases with otosyphilis [5, 6].
Herein, we report the first case of vestibulocochlear neuritis in
an AIDS patient in Korea.
Case Report
A 43-year-old-man, who had been HIV seropositive for 10
years, was admitted with a 4-week history of sudden bilateral
hearing loss and tinnitus. He had a 30 pack-year history of
smoking.
The patient had been diagnosed with HIV infection 10 years
ago, after an unprotected sexual intercourse in Cambodia. He
had initially presented with CMV colitis, accompanied by 20
kg of weight loss, 3 years after the diagnosis of HIV infection.
He was treated with valganciclovir and the antiretroviral drugs
zidovudine/lamivudine (ZDV/3TC) and lopinavir/ritonavir
IgM and IgG antibodies, and Mycoplasma pneumoniae IgM
antibody. Anaerobic cultures of blood displayed no growth for
5 days, whilst sputum culture was positive for Candida albi-
A B
Figure 1. T1-weighted gadolinium-enhanced magnetic resonance images of the internal auditory canal. (A) Unenhanced image of the vestibulocochlear nerves. (B) Abnormal bilateral enhancement of the vestibulocochlear nerves in the internal auditory canal (arrows).
Park HJ, et al. • Vestibulocochlear neuritis in an AIDS patient www.icjournal.org134
cans. Serum polymerase chain reaction for P. jirovecii was
negative.
Although the patient’s pulmonary symptoms resolved after
6 days of trimethoprim-sulfamethoxazole, bilateral SSHL and
dizziness persisted. Cerebrospinal fluid analysis showed a cell
count of 30 cells/μL (mostly lymphocytes), pH of 8.0, glucose
level of 59 mg/dL, and total protein level of 110.3 mg/dL. PCR
for CMV and John Cunningham (JC) virus in the cerebrospi-
nal fluid were negative; results of serological tests for syphilis
and Cryptococcus neoformans antigens also displayed nega-
tive results.
Auditory function tests confirmed the presence of SSHL on
both sides. There were bilateral losses of pure-tone discrimi-
nation mainly in the high frequency range. Pure-tone averages
(PTA) indicated mild hearing loss in the right ear (PTA = 50
dB) and moderate hearing loss in the left ear (PTA = 56 dB).