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.