Audiovestibular neuropathy in an immunocompetent man with cryptococcal meningitis
P Reynard1, A Bascoul2, D Biotti3
1Service d'audiologie et d'explorations otoneurologiques, hôpital Edouard-Herriot, Lyon, France; Université Lyon 1, Lyon, France; Inserm U1120, centre de l'institut Pasteur, institut de l'audition, Paris, France.
Introduction:
Cryptococcus spp. is a fungus responsible for 600,000 deaths per year worldwide, mainly in immunosuppressed subjects. However, 20% of cases occur in immunocompetent subjects. Neuropathic disorders involving the auditory nerve have been reported, but vestibular disorders have never been described in detail. We report the case of an immunocompetent man, who presented audiovestibular disorders leading to a diagnosis of cryptococcal meningitis.
Case Report:
A 39-year-old man was referred for balance disorders and right sensorineural hearing loss. He presented right vestibulo-saccular impairment and bilateral absence of auditory brainstem responses. Brain MRI was suggestive of cryptococcal meningitis. A cystic lesion in the right flocculus compressed the vestibulocochlear nerve. During monthly follow-up, pure tone audiometry gradually improved and speech audiometry in silence returned to normal. Partial resynchronization of the auditory afferent pathways was observed only on the contralateral side to vestibulocochlear nerve compression, while complete recovery of saccular function was observed.
Discussion:
Cryptococcal meningitis in immunocompetent subjects may be accompanied by lesions of the auditory and vestibular afferent pathways. Recovery of hearing and balance was observed in response to medical treatment and early vestibular rehabilitation.
Insights
Cryptococcal meningitis can affect hearing and balance even in immunocompetent individuals. Early treatment and vestibular rehabilitation can lead to recovery of these functions.
Area of Science:
- Neurology
- Infectious Diseases
- Otolaryngology
Background:
- Cryptococcus spp. causes significant mortality, primarily in immunosuppressed individuals.
- Atypical presentations of cryptococcosis, including in immunocompetent hosts, are increasingly recognized.
- Auditory and vestibular neuropathies are known complications, but detailed descriptions are scarce.
Observation:
- A case of an immunocompetent 39-year-old male presenting with balance disorders and sensorineural hearing loss.
- Brain MRI revealed cryptococcal meningitis with a cystic lesion compressing the vestibulocochlear nerve.
- Audiometry and vestibular function showed progressive improvement with treatment.
Findings:
- Cryptococcal meningitis can manifest with audiovestibular deficits in immunocompetent patients.
- The vestibulocochlear nerve compression led to vestibulo-saccular impairment and hearing loss.
- Significant recovery of hearing and vestibular function was observed post-treatment.
Implications:
- Highlights the potential for cryptococcal meningitis to cause audiovestibular damage in immunocompetent individuals.
- Emphasizes the importance of early diagnosis and intervention for hearing and balance recovery.
- Suggests vestibular rehabilitation as a crucial component in managing these neurological complications.
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