1. A case of West Nile viral encephalitis with reversible hearing loss in an immunocompetent patient.
Ambreen Khalil MD, Homer Moutran MD, Cristina Corr PA, Fares Elias MD.
Northwell-Staten Island University Hospital, New York, USA.
Introduction
Audiogram: Pre- steroid therapy & post-steroid therapy
Hospital Course
We present a unique case of a healthy man who presented with moderate to severe bilateral sensorineural hearing loss as well as flaccid paralysis due to West Nile viral (WNV) encephalitis. Upon diagnosis, the patient was aggressively treated with oral steroids that significantly improved his hearing loss. To our knowledge, this is a rare case of reversible sensory loss due to WNV encephalitis.
On fourth day, patient complained of hearing loss, confirmed by an audiogram. At this time, oral prednisone was initiated for five days and tapered over another week.
The patient recovered hearing loss completely as was confirmed by a follow-up audiogram as an oupatient in two months.
Case
Work Up
Hospital Course
Conclusion
A 45 year old man, previously healthy and normoacousic presented to the emergency department (ED) with a fever of F, abdominal pain, nausea, vomiting and weakness. In addition, accompanying family members describe him as having visual hallucinations. The patient had been seen in the ED one day prior and was discharged home with a diagnosis of viral syndrome. He reports eating raw meat about two weeks before symptoms began, and admits to swimming off the coast at an urban island daily. The patient worked at the Parks Department.
Over the next three days, the patient became progressively confused and agitated and was transferred to intensive care unit. Despite broad spectrum antibiotics, the patient continued to spike fevers as high as 103 F. Lumbar puncture revealed high protien and pleocytosis suggesting viral encephalitis; intravenous acyclovir was initiated. High titers of IgM antibodies against WNV in CSF confirmed the diagnosis.
Initial blood count and metabolic panel were within normal limits. Urine and blood cultures was ultimately negative. Abdominal ultrasound revealed mild hepatomegaly. A non-contrast CT of the head was negative. The patient was admitted with a diagnosis of gastroenteritis and treated with ciprofloxacin and metronidazole..
WNV has variable clinical presentation but hearing loss is relatively uncommon. This is a rare description of complete recovery of bilateral of sensorineural hearing loss with use of steroid therapy in an immunocompetent individual and should be considered in select cases, given lack of potent therapeutic options.