title: Reversible hearing impairment: delayed complication of murine typhus or adverse reaction to azithromycin?
abstract: Delayed and reversible hearing loss occurred in a 55-year-old male patient with murine typhus infection. The patient had the initial symptoms of headache, fever and chills, followed by the occurrence of bilateral hearing loss on day 9 from fever onset. Murine typhus was diagnosed with a high IgM titre by indirect immunofluorescence assay. After treatment with azithromycin and prednisolone, the fever and other symptoms subsided gradually and bilateral hearing loss improved 3 weeks later. Though an adverse reaction to azithromycin could not be ruled out, delayed onset of hearing loss was more likely a complication of murine typhus, mainly because the hearing loss did not occur during the azithromycin usage period. Although hearing loss due to murine typhus is rare, clinicians should be alert to the existence of such a delayed complication.
authors.affiliation: Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC.
authors.forename: Shang-Yi
authors.initials: SY
authors.lastname: Lin
authors.affiliation: Department of Pharmacology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC.
authors.forename: Ya-Ling
authors.initials: YL
authors.lastname: Wang
authors.affiliation: Department of Neurology, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.|Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC.
authors.forename: Hsiu-Fen
authors.initials: HF
authors.lastname: Lin
authors.affiliation: Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.|Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC.
authors.forename: Tun-Chieh
authors.initials: TC
authors.lastname: Chen
authors.affiliation: Tropical Medicine Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.|Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.|Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC.
authors.forename: Yen-Hsu
authors.initials: YH
authors.lastname: Chen
authors.affiliation: Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC.|Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC.|College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.|Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.
authors.forename: Po-Liang
authors.initials: PL
authors.lastname: Lu
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000097:blood; D017963:Azithromycin / Q000009:adverse effects* / Q000627:therapeutic use*; D019084:Fluorescent Antibody Technique, Indirect; D034381:Hearing Loss / Q000139:chemically induced / Q000209:etiology*; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D014437:Typhus, Endemic Flea-Borne / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D000907:Antibodies, Bacterial; D007075:Immunoglobulin M; D017963:Azithromycin; D011239:Prednisolone