A case report of Cogan’s syndrome

Cogan syndrome is a rare disorder characterized by recurrent inflammation of the front of the eye (the cornea) and often fever, fatigue, and weight loss, episodes of vertigo (dizziness), tinnitus (ringing in the ears) and hearing loss. It can lead to deafness or blindness if untreated.

An interesting case of Cogan syndrome has appeared in BMJ Case Reports.

A 69-year-old woman presented with a 1-month history of continuous spiking fever, proximal myalgia with weakness, weight loss, intermittent abdominal pain and lower back pain. Except for the use of oral hypoglycaemic drugs to control her diabetes mellitus over the last 7 years, she had been otherwise healthy until she developed these symptoms. Additionally, she had a history of recurrent tinnitus and vertigo for the last 2 years and was suspected to have Ménière’s disease or benign paroxysmal positional vertigo by an otolaryngologist. Seven days prior to her first visit, she developed progressively worsening bilateral deafness.

She was admitted to the surgical ward to assess intermittent abdominal pain and subsequently underwent gynaecological examination; however, no diagnosis was made. Five days after the admission, she developed progressive bilateral blurred visions and an ophthalmologist diagnosed her with uveitis with iridocyclitis and episcleritis (figure 1A). She was then referred to the Department of Medicine since no unifying diagnosis was achieved. At that time, she began experiencing rotational vertigo with nausea, vomiting, and exacerbation of her bilateral hearing loss. The otolaryngologist provided a diagnosis of bilateral sensorineural hearing loss with canal paresis (figure 1B).

Laboratory findings revealed elevated C reactive protein levels and erythrocyte sedimentation rate (86 mm/hour). Serological tests for infectious agents including syphilis yielded negative results. Additionally, both serology for autoimmune diseases and coagulation test yielded negative results. She underwent temporal artery biopsy to preclude the possibility of ischaemic arteritis, which revealed diffuse lymphocytic infiltrates without multinucleated cells (figure 1C). Based on all these findings, a diagnosis of Cogan’s syndrome was considered. She began glucocorticoid therapy, which resulted in the rapid resolution of the high fever, intermittent abdominal pain and proximal myalgia and the gradual improvement in her vestibular symptoms. However, her visual and hearing losses exhibited little improvement...

For more details click on the link: doi:10.1136/bcr-2018-224535