Bilateraler Vestibularisausfall als postinfektiöse Komplikation einer Yersiniose?*

Zusammenfassung

Hintergrund: Yersinien sind Enterobacteriaceae, die altersabhängig unspezifische Infektionssyndrome auslösen können. Als typische Verlaufsformen gelten Enterokolitiden, mesenteriale Lymphadenitiden und Pseudoappendizitiden. Häufig treten Postinfektionssyndrome immunpathologischer Genese auf, die sich in Form von Arthritiden, Arthralgien oder Erythema nodosum manifestieren können. Patienten: Wir berichten über den Fall einer 27jährigen Patientin, bei der drei Jahre nach einer unbehandelten Infektion mit Yersinia enterocolitica ein beidseitiger Vestibularisausfall aufgetreten war. Ergebnisse: Serologisch ließ sich eine signifikante Erhöhung des Antikörper-Titers gegen Y. enterocolitica nachweisen. Alle weiteren diagnostischen Maßnahmen erbrachten keine pathologischen Befunde. Schlußfolgerung: Zirkulierende Immunkomplexe, die als Folge der akuten Infektion im Blut entstehen, werden als Auslöser der extraintestinalen Manifestationen angesehen. Im Innenohr können sie postinfektiöse Immunprozesse mit Autoimmunkomponenten auslösen und einen beidseitigen Vestibularisausfall hervorrufen.

Summary

Background: Yersinia infections other than plaque are caused by Yersinia pseudotuberculosis and Yersinia enterocolitica Food and water contamination as well as animal-to-person and person-to-person contact are common pathways of transmission. Clinical manifestations include enteritis, enterocolitis, acute appendicitis, inflammation of the terminal ileum, and mesenteric adenitis. Y. enterocolitica may cause bacteremia with subsequent septicemia predominantely in patients with underlying illnesses such as diabetes mellitus or malignancy. More frequently enteritis is followed by immunological post-in-fectious Syndromes such as arthritis and erythema nodosum. The present case report discusses bilateral vestibulär loss possibly caused by an infection with Y. enterocolitica. Patients: A 27-year-old caucasian woman initially presented with the otologic Symptom of spinning vertigo accompanied by nausea and vomiting. Results: Physical exam revealed spontaneous nystagmus to the left. Bithermal caloric responses were absent. Pure tone audiometry showed a bilateral Symmetrie high-frequency sensorineural hearing loss. Neurologie exams did not reveal in volvement of the central vestibulär System. Perilymphatic fistula on the left side was exciuded by tympanoscopy. Serology for rheumatoid factors and HLA B27 was negative. Lead or mercury intoxication was also exciuded. In her medical history the patient reported intermittent watery diarrhea and stress dependent arthralgia that had commenced during a stay in Argentina three years ago. Serology was positive, revealing elevated titers for Y. enterocolitica type 3 (1:200) and type 9 (1:400). Discussion: Bilateral vestibulär loss is rare. The main cause is aminoglycoside ototoxicity or meningitis. Yersina infections have not yet been described as inducing disease of the labyrinth. Present pathophysiologic knowledge of yersinia infections is described as follows: After peroral infection, gastrointestinal permeability is increased. Low-molecular-weight substances may enter the bloodstream and stimulate the formation of circulating immune complexes. These are held responsible for extraintestinal manifestations of yersinosis. Whether these circulating immune complexes and antibodies against Y. enterocolitica have an effect on the inner ear remains unclear. Conclusion: Because the eoineidence of yersiniosis and a bilateral vestibulär loss with no other identified cause, a postinfectious immune response is suggested as possible pathogenic mechanism.

Schlüsselwörter

Bilateraler Vestibularisausfall - Yersinia enterocolitica - Postinfektionssyndrom - Zirkulierende Immunkomplexe - Autoimmunprozeß - MALT - Saccus endolymphaticus

Keywords

Bilateral vestibulär loss - Yersinia enterocolitica - Postinfectious Syndrome - Circulating immun complex - MALT - Endolymphatic sac