Behçets Disease Initially Presenting with Meningitis and Sudden Hearing Loss
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概要
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We report a patient with neuro Behçets disease (BD) initially presenting with meningitis and severe hearing loss. A 51-year-old man with no noteworthy past history was hospitalized for evaluation of non-pulsating headache and high fever. Lumbar puncture on admission only showed slight pleocytosis (6 /μL, monomorphonuclear cells predominantly) but no evidence of meningitis. However, after admission, he continued to have a fever of over 38 degrees, and he developed painful oral aphthous ulcer and pseudofolliculitis on the upper limbs and trunk. Prior to admission he had often experienced oral ulceration and had bought commercially available mouthwash for prophylaxis. Subsequently, genital ulceration appeared. A small ulcer was observed at the blood collection site, leading to the diagnosis of BD. On the seventh hospital day, the patient developed sudden hearing loss, which was diagnosed as severe sensorineural hearing loss. Lumbar puncture was performed again. Cerebrospinal fluid (CSF) analysis showed mild pleocytosis (60 /μL, predominantly monomorphonuclear cells), with high CSF IL-6 levels. Neither edematous change nor atrophy of the brainstem was noted and there were no other abnormal findings on the brain MRI/MRA. Auditory brainstem response was normal, suggesting that the patient had developed hearing loss due to peripheral neuropathy. We speculate that the hearing loss was likely due to vasculitis associated with BD. This case is considered to be a rare case of Behçets disease caused by severe hearing loss and meningitis.
著者
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Hatanaka Yuki
Department Of Neurology Teikyo University School Of Medicine
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Yokoe Isamu
Division Of Internal Medicine Itabashi Chuo Medical Center
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Haraoka Hitomi
Division Of Internal Medicine Itabashi Chuo Medical Center
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Kikuchi Tomomi
Division of Rheumatology, Itabashi Chuo Medical Center
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Masuyama Atsushi
Division of Rheumatology, Itabashi Chuo Medical Center
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Maniwa Keiichiro
Division of Rheumatology, Itabashi Chuo Medical Center
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Tsuruta Shinji
Division of Rheumatology, Itabashi Chuo Medical Center
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