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Abstract Details

Bilateral Sensorineural Hearing Loss: A Unique Sequelae of Murine Typhus Aseptic Meningitis
Infectious Disease
P13 - Poster Session 13 (5:30 PM-6:30 PM)
13-011

The first reported case of bilateral sensorineural hearing loss in a patient with aseptic meningitis due to Murine Typhus.
Murine typhus is caused by a gram-negative intracellular bacterium Rickettsia typhi. A flea-borne illness transmitted by the rat flea Xenopsylla cheopis carried by rats, opossums, and cats. In the United States most cases are in Texas, California and Hawaii. It presents with non-specific symptoms making diagnosis difficult. Neurological sequelae of murine typhus are uncommon in comparison to other rickettsial diseases. Headache is common in murine typhus, but meningitis and cranial nerve pathology are rare complications. 

Literature review of reported cases of murine typhus with spinal fluid analysis consistent with aseptic meningitis and cranial nerve sequala. 
A 60-year-old female with a history of lupus presented with headache, fever, and neck stiffness. Social history revealed multiple cats at home. Abnormal vitals on presentation included a temperature of 103 F. Physical exam revealed a non-blanching rash on her face, trunk, and extremities. Laboratory investigations showed elevated liver enzymes. Cerebrospinal fluid showed 41 mg/dL of protein, 54 mg/dL of glucose, and 54 white blood cells (76% lymphocytes). Meningitis/Encephalitis panel by PCR and CSF cultures were negative. Infectious workup revealed R. Typhi IgG/IgM titers of 1:256/1:1,024. She was started on doxycycline with improved in symptoms. She subsequently developed acute bilateral sensorineural hearing loss and received methylprednisolone which improved her hearing.
Aseptic meningitis with cranial nerve involvement can provide a diagnostic clue in the right clinical setting for murine typhus. Two reports of abducens nerve palsy and facial nerve paralysis associated with murine typhus meningitis have been previous reported. This case of bilateral sensorineural hearing loss due to murine typhus meningitis implicates direct pathological involvement of the cochlea or the vestibulocochlear nerve. Recognition of this disease entity is important as treatment response is favorable.
Authors/Disclosures
Justin Samorajski, MD
PRESENTER 		No disclosure on file
No disclosure on file
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