Sensorineural Hearing Loss Combined with Vasculitis

Aim: Allergic angiitis or leukocytoclastic vasculitis is a clinicopathologic entity affecting the small vessels of the skin. Many possible causes exist for this condition, but a cause is not found in as many as 50% of patients. The disorder may be localized to the skin or it may manifest in other organs. We report the case of a woman with sudden hearing loss due to leukocytoclastic vasculitis.

Material: A 57-year-old Greek woman was admitted to our department with hearing loss and tinnitus which had begun suddenly a month earlier. She also complained of blepharoconjuctivitis and subcutaneous nodules of the lower limbs for the previous 3 months with exacerbations and improvements.

Method: Her medical record was unremarkable. She reported no use of drugs. Physical examination revealed vesicular conjunctivitis, probably of staphylococcal origin, and severe disorder of meibomian glands (rosacea). Funduscopy showed no signs of vasculitis of the retina. Examination of the ears, nose, and larynx was normal. Pure tone audiometry revealed a bilateral, medium to severe, sensorineural hearing loss. The tympanograms were of type A, while no acoustic reflex was present. ABR and ENG revealed no pathology. Laboratory tests showed an increase of ESR, CRP, and C3, while C4 was within normal limits. The CBC and common serum markers were normal. The serum protein electrophoresis, the thyroid hormones, and the serum markers indicating neoplasia were within normal limits. The serological testing for hepatitis B, C, and HIV was negative. The immunological testing for RF, ANA, c-ANCA, p-ANCA, anticardiolopin IgM, anticardiolopin IgG, β2GPIIgM, and β2GPIIgG was normal. Chest radiograph showed no pathology. Labial biopsy was negative. Finally, skin biopsy revealed vasculitis of leukocytoclastic type.

Results and Conclusions: Although in cases of leukocytoclastic vasculitis the internal organs affected most commonly are the joints, the gastrointestinal tract, and the kidneys, sudden hearing loss can also be a manifestation of the disease.