Case History/Examination
A 27-year-old man with a history of ulcerative colitis (UC) diagnosed at
19 years old, migraines and childhood asthma presented to the emergency
department (ED) with a 2-week history of severe vertigo, vomiting,
bilateral hearing loss (left ear worse than the right) and tinnitus. He
has a family history of ischaemic heart disease. At the time, the
patient was on Azathioprine for his UC and had been on the medication
for years but was not in remission. On examination by ENT, he was noted
to have left-beating nystagmus and catch-up saccades, and an audiogram
showed mild, symmetrical hearing loss (Figure 1a-1b ). Admission
blood tests, including C-reactive protein (CRP), were unremarkable other
than a slightly raised neutrophil count (Table 1 ). During his
6-day inpatient admission, an MRI of the head and bilateral internal
auditory meatus (IAM) with and without contrast was done, which showed
no mass lesion in the cerebellopontine angle or internal auditory canals
and no cause could be identified for the patient’s symptoms.