Cryptococcal meningitis: presentation as sudden deafness

A patient presented with a bilateral profound hearing loss of sudden onset following a two-month neurologic illness. Microscopy and culture of cerebrospinal fluid revealed Cryptococcus neoformans. Treatment with amphotericin B and 5-fluorocytosine failed to restore hearing. Auditory brain stem response and electrical promontory stimulation suggest a profound deafness with poor neuronal survival. This is consistent with previous temporal bone histopathology reports in individuals dying of cryptococcal meningitis, suggesting a retrocochlear lesion. It is important to exclude this occult pathologic factor in a patient with the sudden onset of sensorineural deafness prior to embarking upon a course of steroid therapy.