A case of atypical Cogan’s syndrome with posterior scleritis and uveitis

[Scleritis and systemic diseases: What should know the internist?]

Scleritis is an inflammatory disease of the sclera; outer tunic of the eye on which the oculomotor muscles are inserted. It can be associated with a systemic disease up to one time out of 3. These associated diseases are mainly rheumatoid arthritis, vasculitis, including granulomatosis with polyangiitis in the first line and spondyloarthropathies. Before mentioning such an etiology, it is necessary to eliminate an infectious cause, mainly herpetic, which is regularly underestimated. The classification of scleritis is clinical. We distinguish between anterior scleritis and posterior scleritis. Anterior scleritis is diffuse or nodular, usually of good prognosis. Anterior necrotizing scleritis with inflammation is often associated with an autoimmune disease, necrotizing scleritis without inflammation usually reflects advanced rheumatoid arthritis. The treatment of these conditions requires close collaboration between internists and ophthalmologists to decide on the use of corticosteroid therapy with or without immunosuppressors or biotherapies.

SEROUS NEUROSENSORY RETINAL DETACHMENT ASSOCIATED WITH ATYPICAL COGAN SYNDROME: A CASE REPORT

PURPOSE

To present a case of a 71-year-old woman with possible focal choroiditis and secondary serous neurosensory retinal detachment associated with atypical Cogan syndrome.

METHODS

Retrospective case report.

RESULTS

On initial evaluation, the patient had decreased vision with photopsias and distortion in the affected eye. Her history revealed 3 years of preexisting neurosensory hearing loss and corneal scarring in the affected eye. Examination findings were significant for unilateral interstitial keratitis and focal macular neurosensory retinal detachment. Fluorescein and indocyanine green angiography demonstrated focal macular leakage and staining. Treatment with intravitreal and periocular steroid injections resulted in complete resolution of the subretinal fluid and visual improvement.

CONCLUSION

Posterior segment manifestations associated with Cogan syndrome are exceedingly rare. This is the first known case of a serous neurosensory retinal detachment from suspected choroidal inflammation associated with Cogan syndrome. Prompt recognition and treatment with corticosteroids may result in anatomical and functional visual improvement, as in this case.