Pulse Corticosteroid Therapy for the Complete Reversal of Severe Bilateral Sudden Sensorineural Hearing Loss in High-Activity Systemic Lupus Erythematosus: A Comprehensive Case Report
DOI:
https://doi.org/10.37275/bsm.v10i5.1580Keywords:
Autoimmune inner ear disease, Methylprednisolone, Pulse therapy, Sudden sensorineural hearing loss, Systemic lupus erythematosusAbstract
Background: Sudden sensorineural hearing loss (SSNHL) is an alarming otologic emergency. While predominantly idiopathic, it can manifest as a rare, severe complication of autoimmune disorders, including systemic lupus erythematosus (SLE). The underlying pathophysiology in SLE-induced SSNHL often involves aggressive microvascular compromise and immune complex deposition.
Case presentation: We present the case of a 21-year-old female with a history of SLE, congestive heart failure, and previous non-hemorrhagic stroke, who presented with acute-onset bilateral hearing loss of one day's duration. She exhibited high SLE disease activity with a MEX-SLEDAI score of 12. Initial pure-tone audiometry revealed very severe SSNHL in the right ear (Air Conduction [AC] 98.75 dB) and severe SSNHL in the left ear (AC 87.5 dB). Due to resource constraints, advanced immunological testing was unavailable; however, a severe lupus flare was confirmed clinically. The patient was immediately treated with intravenous methylprednisolone pulse therapy (500 mg/day) followed by an oral tapering regimen. Subsequent audiometric evaluations demonstrated rapid, complete audiological recovery to normal thresholds bilaterally.
Conclusion: High-dose systemic corticosteroid pulse therapy, when initiated within 24 hours of symptom onset, can achieve complete reversal of severe bilateral SSNHL in patients with high-activity SLE. Rapid recognition and aggressive immunosuppression are vital to rescuing cochlear function, even in resource-limited clinical environments.
Authors
- Ida Ayu Ide Larassanthi Pratiwi1*
- I Made Wiranadha1
- I Gede Wahyu Adi Raditya1
- 1Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Universitas Udayana/Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Indonesia
Corresponding author Ida Ayu Ide Larassanthi Pratiwi — larassanthiide@gmail.com
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