Figure 1: CXR postero anterior view showing segmental consolidation of
right lower zone
There was no clinical improvement after 72 hours of antibiotic therapy.
Intravenous ciprofloxacin was administered based on sputum culture and
antibiotic sensitivity test for 3 days. Her respiratory symptoms
improved but still remained febrile. She complained of bilateral hearing
loss after 3-4 days of admission and appeared delirious on examination.
She didnot complain of tinnitus or otalgia. Urgent MRI brain showed no
significant abnormalities although minor details could not be reported
due to frequent motion by the agitated patient. Repeat serological
investigation showed positive IgM for scrub typhus. Other hematological
investigations including complete blood count, liver functions and renal
functions did not show significant changes compared to previous results.
She responded to oral azithromycin 1gm daily for 03 days. Induction of
labour was done in view of fetal jeopardy and delivered a male baby
weighing 2100 grams with Apgar score of 9 and 10 at 1 and 5 minutes
respectively. There were no intrapartum and immediate post partum
complications. Audiology examination done postpartum 3rd day showed
profound bilateral hearing loss (Figure 2). Audiology re-assessment was
done at 6 and 12 weeks postpartum.
Clinically, there was no improvement in her hearing and repeat Pure Tone
Audiometry (PTA) at 12 weeks (Figure 3) still showed profound bilateral
hearing loss similar to the initial assessment. A retrospective
diagnosis of permanent hearing loss following scrub typhus in pregnancy
was made. Auditory Brainstem Response (ABR) was not performed as MRI
brain performed earlier did not identify any retrocochlear lesions and
PTA findings were sufficient to assess the hearing threshold. She was
advised to adopt total communication as an alternative.