Cogan syndrome associated with mesenteric vascular insufficiency

[Vascular involvement in Cogan's syndrome. A case report]

Vascular manifestations of Cogan's syndrome are rarely reported. We report the case of a young woman followed for typical Cogan's disease. Serious vascular involvement was found only during work-up for arterial hypertension. This case highlights potentially asymptomatic nature of extensive vasculitis affecting large and medium-sized vessels in Cogan's disease. Careful screening is required to prevent life-threatening complications.

Thoracoabdominal aortic aneurysm in Cogan's syndrome

Cogan's syndrome is an autoimmune disease of unknown etiology, clinically manifested as non-syphilitic interstitial keratitis and audiovestibular symptoms. Increasing evidence suggests that Cogan's may be a systemic vasculitis. In this report, we review the vascular manifestations of Cogan's syndrome and report two cases of thoracoabdominal aortic aneurysm in patients with this disorder.

Intestinal (mesenteric) vasculopathy. II. Ischemic colitis and chronic mesenteric ischemia

Ischemic colitis accounts for approximately half of all cases of mesenteric vasculopathy. The clinical presentation varies depending on underlying cause, extent of vascular obstruction, rapidity of ischemic insult, degree of collateral circulation, and presence of comorbidity. Ischemic colitis is usually diagnosed by colonoscopy. Only approximately 20% of patients require surgery because of signs or laboratory findings of peritonitis or because of clinical deterioration. Approximately 20% of patients develop chronic colitis from irreversible colonic ischemic injury, which manifests clinically as persistent diarrhea, rectal bleeding, or weight loss and endoscopically as a colonic stricture or mass. Chronic mesenteric ischemia is almost always caused by significant atherosclerotic stenosis involving at least two mesenteric arteries, usually the superior mesenteric artery and celiac axis. The classic symptomatic triad of postprandial pain, fear of eating, and involuntary weight loss occurs with advanced disease.

Popliteal artery thrombosis in a patient with Cogan syndrome: treatment with thrombolysis and percutaneous transluminal angioplasty

A 31-year-old woman with Cogan syndrome (a rare form of systemic vasculitis) was evaluated for a cold, painful left foot with diminished pulses. Arteriography demonstrated thrombosis of the left popliteal artery with evidence of vasculitis. Thrombolytic therapy was begun with initial success but eventual rethrombosis. After reinitiating thrombolytic therapy combined with intraarterial vasodilator therapy, successful angioplasty was performed with sustained results at 6-month follow-up.

Association of Crohn's disease and Cogan's syndrome

We describe the case of a young woman with Cogan's syndrome and associated Crohn's disease. Systemic disease was manifested by oligoarthritis and valvular involvement. Crohn's disease has previously been described in two cases of Cogan's syndrome. We suggest therefore that Crohn's disease is pathogenetically related to Cogan's syndrome. For both, systemic involvement is characteristic, and immune-mediated mechanisms and vasculitis are thought to play a major pathogenetic role. Furthermore, both respond to treatment with corticosteroids.

Case report: clinical and radiological features of Cogan's syndrome--non-syphilitic interstitial keratitis, audiovestibular symptoms and systemic manifestations

The case is presented of a 23-year-old man with Cogan's syndrome, who died from spontaneous rupture of a renal artery 2 years after developing symptoms, despite treatment with corticosteroids and azathioprine. The typical clinical features, investigations and radiological findings of this rare disease are described, particularly the systemic vasculitis and its angiographic and ultrasound appearances.

Cogan's syndrome with aortitis, aortic regurgitation, and aortic arch vessel stenoses

Cogan's syndrome of interstitial keratitis and vestibuloauditory dysfunction is rare. Systemic vasculitic manifestations occur, and 10% of patients with this syndrome have aortic valvular disease. A patient with Cogan's syndrome is presented who had aortitis of the ascending thoracic aorta, severe aortic valve regurgitation, orificial stenosis of the right coronary artery, and orificial stenoses of all three aortic arch vessels. Histopathology confirmed aortitis. Aortic valve replacement combined with coronary and aortic arch vessel reconstruction was required for correction.

Cogan's syndrome: 18 cases and a review of the literature

In this article, we review 78 cases of Cogan's syndrome--18 from our institution and 60 from the English medical literature--and describe the clinical, laboratory, radiographic, and pathologic findings associated with this disorder. Patients with Cogan's syndrome should be examined by an ophthalmologist, otolaryngologist, and internist because, in addition to the eye and audiovestibular involvement, systemic manifestations are common. An elevated erythrocyte sedimentation rate, anemia, leukocytosis, and thrombocytosis are common but nonspecific laboratory abnormalities. Serious outcomes include deafness and, less frequently, vasculitis, aortic insufficiency, blindness, and death. Glucocorticoids seem to be effective therapy for active Cogan's syndrome. Aortic valve replacement and vascular bypass grafting are indicated in selected cases. The roles of cytotoxic-immunosuppressive agents and cochlear implantation remain to be clarified.

Cogan's syndrome: acute vestibular and auditory dysfunction with interstitial keratitis

Two patients with Cogan's syndrome had acute bilateral hearing loss and vestibular dysfunction. Interstitial keratitis was discovered by slit-lamp examination. Both cases responded to corticosteroid treatment. Immediate recognition of this syndrome and the institution of high-dose corticosteroid therapy should lead to resolution of the hearing loss in patients with Cogan's syndrome.

[Atypical Cogan's syndrome with cutaneous vasculitis: a case]

The authors report the case of a 81 years-old-woman who had simultaneously atypical Cogan's syndrome, cutaneous vasculitis and diverticular sigmoiditis. The relations being between these three diseases are discussed.