OBJECTIVE: To report a case of rapid hearing loss caused by cryptococcal meningitis in an immunocompetent patient. CASE REPORT: A 48-year-man presented at our ear, nose, and throat (ENT) ambulatory clinic with complaints of sudden hearing loss for 24 hours without any other symptoms. Normal ENT examination and otoscopy revealed no abnormalities in the cranial nerves. An audiogram showed severe sensorineural hearing loss in the right ear and moderate hearing loss and 8% speech recognition at 100 dB in the left ear. The right ear did not show speech recognition. The patient was administered prednisone 60 mg/day and was requested to return in 24 hours for audiometry. The patient returned with complaints of tremors in his upper limbs and intense headaches, which worsened with change in recumbency. Neurological examinations revealed an altered mental status, normal results in cerebellar tests, preserved strength, and no signs of meningeal disorders. The patient was admitted to the Neurology Clinic with a tentative diagnosis of piriform sinus thrombosis. Corticosteroid therapy was discontinued. A computed tomography (CT) scan and brain magnetic resonance imaging (MRI) was suggested along with assessment of serum levels of antibodies to HIV and hepatitis B and C, a complete blood count (CBC), and analysis of the cerebrospinal fluid (CSF) using India ink. All laboratory tests yielded normal results except for a positive CSF analysis; therefore, a CSF culture was carried out. The imaging test showed no lesions in the central nervous system (CNS). The patient was treated with amphotericin deoxycholate 50 mg/day and fluconazole 800 mg/day. During internation, the patient developed hydrocephalus, renal failure, and gait ataxia, which were treated with repeated CFC punctures. Amphotericin deoxycholate was replaced with liposomal amphotericin. After 4 days, audiometry was performed again and revealed bilateral anacusia. The patient was discharged with hearing improvement, and currently is an outpatient. CONCLUSION: Cryptococcal meningitis should be considered a cause of rapid hearing loss even in immunocompetent individuals.
