Bilateral sensorineural deafness associated with Mycoplasma pneumoniae infection: the first case report.

We report an 11-year-old girl, who suffered from Mycoplasma pneumoniae pneumonia, meningitis, and mild, bilateral, acute otitis media, with subsequent severe, mixed hearing loss. The patient presented extremely high Mycoplasma pneumoniae complement fixation and cold hemagglutinin titers, the unique chest x-rays indicating mycoplasma pneumonia, and cerebrospinal fluid suggestive of meningitis. A moderate grade of sensorineural hearing loss that was seen in the early clinical stage has not shown any improvement, although the other signs and symptoms have resolved. Possible causative relationships of Mycoplasma pneumoniae to otologic complications, especially those closely related to pel"'ipheral nerve impairments, were discussed. INTRODUCTION CASE PRESENTATION 585 Mycoplasma pneumoniae (MP), long known as a causative organism of 11 to 40 % of respiratory disease in man, especially primary atypical pneumonia, is receiving increasing attention recently because it also causes diverse complications involving various other organs and tissues such as the gastrointestinal, urogenital, nervous and cardiovascular systems, blood, skin, joints and muscles. Sometimes, clinical course is serious with poor prognosis. The complications affecting the central nervous system (CNS) are incresing and now accounting approximately 5 to 7% of all the MP infections2•5•8•9'. This report describes a case of MP causing primary atypical pneumonia complicated first by meningitis and otopathy, and finally with bilateral, high-degree, sensorineural hearing loss. An 11-year-8-month-old female was in good health until five days prior to visiting a physician when she developed nonproductive cough and low-grade fever. She was admitted to a hospital because of suspected pneumonia by chest x-rays. On admission, C-reactive protein was three-positive, cold hemagglutinin (CHA) titer 1: 128 and complement fixation (CF) titer 1: 8 (Table 1, Fig. 1). Other routine laboratory data were noncontributory. Chest x-rays showed a soft, diffuse shadow in the left lower lung field, disappearance of the left diaphragm line, appearance of a rather broad hairline in the region corresponding to between the right middle and lower lobes, and rightward enlargement with rectilinearization of the mediastinum shadow. A high fever of 38 to 39° C persisted after admission. On February 5, 1981, she developed otorrhea and complained of deafness the next *> fmll6J~fr, 11i*llilc00, #l"~~T, ~EE tflf., f* ]@:, EE1rF~M€: Mycoplasma pneumoniae ~~~ftt~ Lt.:.ft!U -OlU~iif1~U~~ **> To whom all correspondence should be made. 586· K. Nishioka et al. 1981. 2. 4. 2. 10. 2. 20 3. 1. 3. 10. hospital day 5~h 19th l~th 20th 25tb 30th 35th I _EM oL ___ cGM::J c:='.::cEx===::j c==::cEz==::::i • PIPc::r:=:::: AMPC===:J r·globulin c=::::::J Dr-globulin · CJ. C::-:-:: . . '-----'-_.MINO . It. tymp. hydrocortisone hydrocortisone It. paracentesis tY.,&P· rt. pagcentes1s tymp. pun~ure ATP~ · ~ATP==:--i fever ('C) 40 39· 38 371_ ___,,_ _ _.,_....._