[Autoimmune hearing loss in giant cell arteritis: a clinical case]

Giant cell arteritis (GCA), also called as temporal arteritis, is a systemic vasculitis, primary affecting individuals over 50 years of age and mostly women. The disease can manifest with symptoms of systemic inflammatory response syndrome as well with symptoms of systemic vasculitis affecting mainly medium and large vessels, including branches of the carotid artery, first of all the ophthalmic and temporal. Pathogenetically, arterial damage in GCA is a combination of autoinflammatory and autoimmune processes, resulting in vascular wall remodeling with narrowing of the arterial lumen and subsequent ischemia in the affected organs and tissues. One of the uncommon symptoms of GCA, which in some cases may precede the onset of the disease, is cochleovestibular dysfunction, in particular sensorineural hearing loss, which might occur in 25-60% of GCA cases. The clinical case of untypical GCA was shown. The disease manifested after SARS-Cov-2 infection as the subacute rhinosinusitis and bilateral otitis media with effusion that finally resulted in profound mixed hearing loss. The clinical features of the disease looked like granulomatosis with polyangiitis, however, no increase in antinuclear and antineutrophil cytoplasmic antibody levels was detected. A specific clinical feature with unilateral vision loss after 12 months from the disease onset could help to verify it. Urgently corticosteroid therapy let us relieve both main symptoms and rhinosinusitis with bilateral otitis media with effusion that resulted in significant hearing improvement. It has been suggested that the combination of middle and inner ear lesions in this case could either be a consequence of the simultaneous development of GPA and GCA, or was the result of coincidence of a number of their pathogenesis links, specifically the activation of B cells, as well as excessive proliferation of monocytes/macrophages producing metalloproteinase-9.