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.