To present an unusual cause of bilateral sensorineural hearing loss mimicking chemotherapy-induced ototoxicity.Patient:
A 76-year-old woman with bilateral sudden sensorineural hearing loss after chemotherapy for non-Hodgkin lymphoma was referred for cochlear implantation.Interventions:
Prednisone and acyclovir were administered empirically during the course of the diagnostic evaluation.Main Outcome Measures:
Diagnostic tests were obtained, including audiometry, positron emission tomography/computed tomographic imaging, and magnetic resonance imaging scan of the brain with gadolinium.Results:
Audiometry revealed bilateral profound sensorineural hearing loss without improvement after steroid and acyclovir treatment. Postchemotherapy positron emission tomography/computed tomographic imaging obtained 1 week after onset of hearing loss suggested the lymphoma to be in remission. However, magnetic resonance imaging obtained a few weeks later, concurrent with progression of symptoms to include facial palsy and numbness, demonstrated enhancement and thickening of multiple cranial nerves, consistent with neurolymphomatosis (malignant lymphocytic infiltration of nerves).Conclusion:
Particular vigilance must be given to the potential for malignant invasion of the peripheral nervous system in the context of new-onset sensorineural hearing loss after chemotherapy. Such a neurologic deficit should not be assumed to be chemotherapy induced even if the hearing loss is bilaterally symmetric and the only neurologic abnormality.