Otosyphilis in HIV-Coinfected Patient with Unique Otologic Manifestations

Abstract

Syphilis used to be a common cause of sensorineural hearing loss. The incidence has decreased markedly after the introduction of penicillin, however, there was recent increase in parallel with HIV infection. Otosyphilis, characterized by cochleovestibular dysfunction, is one of the clinical presentations in syphilis. We describe the unique otologic findings and clinical outcomes of a case diagnosed as otosyphilis in HIV-infection. A 55-year-old man was referred to our department of Kagoshima University Hospital for evaluation of hearing loss in his right ear. He had suffered from right ear fullness and the rash on his face for one month and half, and hearing loss in his right ear occurred suddenly one week ago. The patient showed moderate sensorineural hearing impairment in the right ear on pure tone audiometry. Because his facial skin lesion was diagnosed as seborrheic dermatitis by dermatologist and the patient was treated for having Entamoeba histolytica infection eight years ago, HIV infection was highly suspected. Serological examinations revealed HIV and syphilis infection and the patient was diagnosed as otosyphilis with HIV-infection. Other neurologic tests and imaging study were normal. Hearing impairment in the right ear improved with a 9-week course of amoxicillin of 1500mg/day orally. This case provides evidence that auditory findings arise as the initial manifestation of shyphilis in HIV-coinfected patient. Therefore, careful evaluation is needed in diagnosis of patients with hearing loss.