A woman in her late 40s who works as a veterinary technician represented to the emergency department with increasing headache, confusion, neck stiffness, subjective fevers and distorted hearing 2 days after diagnosis of viral infection at an outside emergency department.
Diagnosis of Pasteurella multocida was made from blood cultures and lumbar puncture. Intravenous ceftriaxone was administered for 21 days. By the time of resolution of acute meningitis, she had become completely deaf bilaterally. MRI revealed faint early ossification/possible labyrinthitis ossificans of the basal cochlea, which was confirmed on surgical exploration during the placement of cochlear implants bilaterally 42 days later. We discuss how the atypical features of this infection lead to diagnostic delay and high morbidity, the unique imaging/surgical findings resulting from the infection, and the clinical utility of early and bilateral cochlear implantation in this and similar cases.
- Otolaryngology / ENT
- Infection (neurology)
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Contributors JDW drafted, edited and revised the manuscript, wrote response letter to revisions, designed the case layout/reporting of information, contributed to final approval of the publication, and agrees to accountability for accuracy and integrity of the work. JDW is the corresponding and submitting author, as well as guarantor. AMT contributed to the conception of the work, critically edited the work, contributed to revisions, revision responses and letters, critiqued the case layout/reporting of information, contributed to final approval of the publication, and agrees to accountability for accuracy and integrity of the work. AMT also contributed to the care of the patient. SM contributed to edits of the draft paper, as well as the acquisition of data for the work, contributed to final approval of the publication, and agrees to accountability for accuracy and integrity of the work. EW contributed to conception of the work, to revisions and edits of the draft, to final approval of the publication, and agrees to accountability for accuracy and integrity of the work. EW also contributed to the care of the patient. EW is senior author.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.