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Oueslati Y, Bouchoucha S, Abdaoui M, Khallouli A, Maalej A, Rannen R. Atypical Cogan's syndrome: A case report. J Fr Ophtalmol 2024; 47:104044. [PMID: 38194861 DOI: 10.1016/j.jfo.2023.104044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 01/11/2024]
Abstract
Cogan's syndrome is a rare autoimmune inflammatory disease, characterized by interstitial keratitis and audio-vestibular signs. The syndrome was first described in 1945 by David G. Cogan. Then, it was only in 1980 when Haynes et al. proposed diagnostic criteria for patients with other symptoms and was qualified as atypical form of Cogan's syndrome. Herein, we report a case of a 28-year-old woman with atypical Cogan's syndrome. The patient was treated with corticosteroids and received a cochlear implant.
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Affiliation(s)
- Y Oueslati
- Department of ophthalmology, Principal Military Hospital, Tunis, Tunisia; College of Medicine, University of Tunis-El Manar, Tunis, Tunisia.
| | - S Bouchoucha
- Department of ophthalmology, Principal Military Hospital, Tunis, Tunisia; College of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - M Abdaoui
- Department of ophthalmology, Principal Military Hospital, Tunis, Tunisia; College of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - A Khallouli
- Department of ophthalmology, Principal Military Hospital, Tunis, Tunisia; College of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - A Maalej
- Department of ophthalmology, Principal Military Hospital, Tunis, Tunisia; College of Medicine, University of Tunis-El Manar, Tunis, Tunisia
| | - R Rannen
- Department of ophthalmology, Principal Military Hospital, Tunis, Tunisia; College of Medicine, University of Tunis-El Manar, Tunis, Tunisia
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Hara K, Umeda M, Segawa K, Akagi M, Endo Y, Koga T, Kawashiri SY, Ichinose K, Nakamura H, Maeda T, Kawakami A. Atypical Cogan's Syndrome Mimicking Giant Cell Arteritis Successfully Treated with Early Administration of Tocilizumab. Intern Med 2022; 61:1265-1270. [PMID: 34615818 PMCID: PMC9107983 DOI: 10.2169/internalmedicine.7674-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
A 49-year-old Japanese man with a 2-month history of a fever, headache, and bilateral conjunctival hyperemia was admitted. His condition fulfilled the giant cell arteritis classification criteria (new headache, temporal artery tenderness, elevated ESR) and atypical Cogan's syndrome (CS) with scleritis and sensorineural hearing loss (SNHL). The interleukin (IL)-6 serum level was extremely high. Two weeks after his insufficient response of SNHL and scleritis to oral prednisolone, we administered tocilizumab (TCZ); rapid improvements in scleritis and SNHL occurred. Early IL-6 target therapy can help prevent irreversible CS-induced sensory organ damage.
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Affiliation(s)
- Kazusato Hara
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Masataka Umeda
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
- Medical Education Development Center, Nagasaki University Hospital, Japan
- Department of General Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Keiko Segawa
- Department of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Midori Akagi
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Yushiro Endo
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Shin-Ya Kawashiri
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Kunihiro Ichinose
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Hideki Nakamura
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Takahiro Maeda
- Department of General Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
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3
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Padoan R, Cazzador D, Pendolino AL, Felicetti M, De Pascalis S, Zanoletti E, Bovo R, Martini A, Schiavon F. Cogan’s syndrome: new therapeutic approaches in the biological era. Expert Opin Biol Ther 2019; 19:781-788. [DOI: 10.1080/14712598.2019.1611779] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Roberto Padoan
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Diego Cazzador
- Otorhinolaryngology Unit, Department of Neurosciences, University of Padova, Padova, Italy
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| | - Alfonso Luca Pendolino
- Otorhinolaryngology Unit, Department of Neurosciences, University of Padova, Padova, Italy
| | - Mara Felicetti
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Susanna De Pascalis
- Emergency Unit, Department of Medicine and Surgery, University of Bologna, Bologna, Italy
| | - Elisabetta Zanoletti
- Otorhinolaryngology Unit, Department of Neurosciences, University of Padova, Padova, Italy
| | - Roberto Bovo
- Otorhinolaryngology Unit, Department of Neurosciences, University of Padova, Padova, Italy
| | - Alessandro Martini
- Otorhinolaryngology Unit, Department of Neurosciences, University of Padova, Padova, Italy
| | - Franco Schiavon
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
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Autoimmune Inner Ear Disease: Immune Biomarkers, Audiovestibular Aspects, and Therapeutic Modalities of Cogan's Syndrome. J Immunol Res 2018; 2018:1498640. [PMID: 29850616 PMCID: PMC5937438 DOI: 10.1155/2018/1498640] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 03/21/2018] [Indexed: 01/08/2023] Open
Abstract
Cogan's syndrome (CS) is a rare autoimmune disorder characterized by audiovestibular dysfunction and ocular inflammation. Currently, there is no specific serum autoantibody used in the diagnostic workup of CS. Treatment is based on immunosuppressive agents, mainly corticosteroids as first-line choice. Recently, novel therapeutic modalities in CS have emerged. These include tumor necrosis factor-α inhibitors and other biologicals. Despite medical treatment, hearing loss may progress to irreversible bilateral profound SNHL in approximately half of CS patients resulting in candidacy for cochlear implantation (CI). Due to the inflammatory nature of the disease that is causing endosteal reaction with partial obliteration or complete neoossification of the intracochlear ducts, early CI is recommended. CI provides excellent and stable hearing rehabilitation with high score of word and sentence recognition. In this review, we will discuss different aspects of CS including clinical presentation, diagnosis, treatment, and future directives.
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D’Aguanno V, Ralli M, de Vincentiis M, Greco A. Optimal management of Cogan's syndrome: a multidisciplinary approach. J Multidiscip Healthc 2017; 11:1-11. [PMID: 29317827 PMCID: PMC5743115 DOI: 10.2147/jmdh.s150940] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Cogan's syndrome (CS) is a rare disorder characterized by nonsyphilitic interstitial keratitis (IK) and audio-vestibular symptoms. CS affects mainly young Caucasian adults, mostly during their first three decades of age, and may develop into typical and atypical variants. Typical CS manifests primarily with IK and hearing loss, whereas atypical CS usually presents with inflammatory ocular manifestations in association with audio-vestibular symptoms but mostly different Ménière-like symptoms and, more frequently, with systemic inflammation (70%), of which vasculitis is the pathogenic mechanism. CS is considered as an autoimmune- or immune-mediated disease supported mainly by the beneficial response to corticosteroids. Using well-developed assays, antibodies to inner ear antigens, anti-Hsp70, and antineutrophil cytoplasmic antibodies were found to be associated with CS. Corticosteroids represent the first line of treatment, and multiple immunosuppressive drugs have been tried with variable degrees of success. Tumor necrosis factor-alpha blockers and other biological agents are a recent novel therapeutic option in CS. Cochlear implantation is a valuable rescue surgical strategy in cases with severe sensorineural hearing loss unresponsive to intensive and/or innovative immunosuppressive regimens.
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Affiliation(s)
| | - Massimo Ralli
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
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Durtette C, Hachulla E, Resche-Rigon M, Papo T, Zénone T, Lioger B, Deligny C, Lambert M, Landron C, Pouchot J, Kahn JE, Lavigne C, De Wazieres B, Dhote R, Gondran G, Pertuiset E, Quemeneur T, Hamidou M, Sève P, Le Gallou T, Grasland A, Hatron PY, Fain O, Mekinian A. Cogan syndrome: Characteristics, outcome and treatment in a French nationwide retrospective study and literature review. Autoimmun Rev 2017; 16:1219-1223. [DOI: 10.1016/j.autrev.2017.10.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 08/14/2017] [Indexed: 10/18/2022]
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Ocular, Auricular, and Oral Manifestations of Inflammatory Bowel Disease. Dig Dis Sci 2017; 62:3269-3279. [PMID: 29064013 DOI: 10.1007/s10620-017-4781-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 09/22/2017] [Indexed: 12/16/2022]
Abstract
Inflammatory bowel disease (IBD) is primarily a disease of the gastrointestinal tract, though it can often affect other organ systems. These extraintestinal manifestations occur in a quarter to one-third of patients with Crohn's disease and ulcerative colitis. While musculoskeletal and dermatologic manifestations are the most common, it is also important to be cognizant of head, eye, ear, nose, and throat (HEENT) manifestations and educate IBD patients about them. Here we review the ocular manifestations in conjunction with the lesser-known but increasingly recognized ENT manifestations. Considering the lack of randomized controlled trials in treating HEENT manifestations of IBD, this review is primarily based on case reports, case series, and expert opinion with a particular focus on the newer literature supporting use of anti-TNF agents.
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Mora P, Calzetti G, Ghirardini S, Rubino P, Gandolfi S, Orsoni J. Cogan's syndrome: State of the art of systemic immunosuppressive treatment in adult and pediatric patients. Autoimmun Rev 2017; 16:385-390. [DOI: 10.1016/j.autrev.2017.02.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 12/29/2016] [Indexed: 12/29/2022]
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Vavricka SR, Greuter T, Scharl M, Mantzaris G, Shitrit AB, Filip R, Karmiris K, Thoeringer CK, Boldys H, Wewer AV, Yanai H, Flores C, Schmidt C, Kariv R, Rogler G, Rahier JF. Cogan's Syndrome in Patients With Inflammatory Bowel Disease--A Case Series. J Crohns Colitis 2015; 9:886-90. [PMID: 26188351 DOI: 10.1093/ecco-jcc/jjv128] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 07/10/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cogan's syndrome (CSy) is a very rare autoimmune disorder, mainly affecting the inner ear and the eye, and is associated with inflammatory bowel disease (IBD). METHODS This was a European Crohn's and Colitis Organisation (ECCO) retrospective observational study, performed as part of the CONFER project. A call to all ECCO members was made to report concomitant CSy and inflammatory bowel disease (IBD) cases. Clinical data were recorded in a standardized questionnaire. RESULTS This international case series reports on 22 concomitant CSy-IBD cases from 14 large medical centres. Mean duration of IBD until diagnosis of CSy was 8.7 years (range 0.0-38.0) and mean age at CSy diagnosis was 44.6 years (range 9.0-67.0). Six patients had underlying ulcerative colitis (UC) and 16 had Crohn's disease. Eleven patients (50%) had active disease at CSy diagnosis. Sixteen patients were under IBD treatment at the time of CSy diagnosis, of whom 6 (37.5%) were on anti-tumour necrosis factor (TNF). Seven out of 10 patients, who were treated for CSy with immunomodulators (mostly with corticosteroids), demonstrated at least partial response. CONCLUSION This is the largest CSy-IBD case series so far. Although CSy is considered to be an autoimmune disease and is associated with IBD, immunomodulatory IBD maintenance treatment and even anti-TNF therapy do not seem to prevent disease onset. Moreover, IBD disease activity does not seem to trigger CSy. However, vigilance may prompt early diagnosis and directed intervention with corticosteroids at inception may potentially hinder audiovestibular deterioration. Finally, vigilance and awareness may also offer a better setting to study the pathophysiological mechanisms of this rare but debilitating phenomenon.
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Affiliation(s)
- Stephan R Vavricka
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland Division of Gastroenterology and Hepatology, Triemli Hospital Zurich, Zurich, Switzerland
| | - Thomas Greuter
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Michael Scharl
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Ariella B Shitrit
- Digestive Diseases Institute, Shaare Zedek Medical Center, Hebrew University Medical School, Jerusalem, Israel
| | - Rafal Filip
- Department of Clinical Endoscopy, Institute of Rural Health, Lublin, Poland
| | - Konstantinos Karmiris
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Crete, Greece
| | - Christoph K Thoeringer
- II. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Hubert Boldys
- Department of Gastroenterology and Hepatology, Medical University of Silesia, Katowice, Poland
| | - Anne V Wewer
- Department of Pediatrics, Hvidovre University Hospital, Hvidovre, Denmark
| | - Henit Yanai
- IBD Center, Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Cristina Flores
- Gastroenterology Section, Porto Alegre Clinical Hospital, Federal University of Rio Grande do Sul, Porto Alegre, Brasil
| | - Carsten Schmidt
- Department of Gastroenterology, University Hospital Jena, Jena, Germany
| | - Revital Kariv
- Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Gerhard Rogler
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Jean-François Rahier
- Department of Hepatogastroenterology, CHU Dinant Godinne, UCL Namur, Yvoir, Belgium
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Abstract
Cogan and Behcet syndromes are considered large vessel vasculitides. Both are rare diseases, with varied clinical manifestations affecting multiple organ systems. Although both have hallmark symptoms (ocular and vestibuloauditory inflammation in Cogan syndrome and aphthous ulcers in Behcet syndrome), neither has confirmatory diagnostic testing. Delayed diagnosis can result in poor outcomes. In both syndromes, large vessel arterial inflammation may result in severe morbidity and mortality. Treatment strategies in both syndromes vary based on organ system involvement and severity of manifestations. In this article, the epidemiology, proposed pathogenesis, manifestations, and the most current treatment paradigms for these syndromes are reviewed.
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11
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Orsal E, Uğur M, Seven B, Ayan AK, Içyer F, Yıldız A. The Importance of FDG-PET/CT in Cogan's Syndrome. Mol Imaging Radionucl Ther 2014; 23:74-5. [PMID: 24963451 PMCID: PMC4067882 DOI: 10.4274/mirt.349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 07/25/2012] [Indexed: 12/01/2022] Open
Abstract
The present study gives a detailed report of a patient with atypical Cogan's syndrome with uveitis and sensorineural hearing loss. Cogan's syndrome is characterized by nonsyphilitic interstitial keratitis and audiovestibular dysfunction. This syndrome can be divided into two groups, typical and atypical, based on the presence of interstitial keratitis. It may sometimes be associated with systemic vasculitis. Fluoro-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) scanning was used to investigate the presence of vasculitis. With FDG-PET/CT scanning, there is no pathological involvement in the walls of the arteries; thus the patient is protected from aggressive and long term immunosuppressive treatment's side effects. Hence, we can conclude that FDG-PET/CT may play an important role in excluding the presence of vasculitis.
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Affiliation(s)
- Ebru Orsal
- Atatürk University Faculty of Medicine, Department of Nuclear Medicine, Erzurum, Turkey
| | - Mahir Uğur
- Atatürk University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Erzurum, Turkey
| | - Bedri Seven
- Atatürk University Faculty of Medicine, Department of Nuclear Medicine, Erzurum, Turkey
| | - Arif Kürşad Ayan
- Atatürk University Faculty of Medicine, Department of Nuclear Medicine, Erzurum, Turkey
| | - Fatma Içyer
- Atatürk University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Erzurum, Turkey
| | - Aslı Yıldız
- Atatürk University Faculty of Medicine, Department of Nuclear Medicine, Erzurum, Turkey
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12
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Cogan syndrome — Pathogenesis, clinical variants and treatment approaches. Autoimmun Rev 2014; 13:351-4. [DOI: 10.1016/j.autrev.2014.01.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2013] [Indexed: 01/09/2023]
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13
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Azami A, Maleki N, Kalantar Hormozi M, Tavosi Z. Interstitial Keratitis, Vertigo, and Vasculitis: Typical Cogan's Syndrome. Case Rep Med 2014; 2014:830831. [PMID: 24715922 PMCID: PMC3970326 DOI: 10.1155/2014/830831] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 01/30/2014] [Indexed: 11/17/2022] Open
Abstract
Cogan's syndrome (CS) is a chronic inflammatory disorder of unknown etiology that most commonly affects young adults. Clinical hallmarks are bilateral interstitial keratitis and vestibuloauditory dysfunction. Association between CS and systemic vasculitis as well as aortitis also exists. The diagnosis of CS is based upon presence of characteristic inflammatory eye disease and vestibuloauditory dysfunction. We describe classic Cogan's syndrome in a 47-year-old female from Ardabil. The patient was admitted with headache, vertigo, nausea, vomiting, right leg claudication, musculoskeletal pains, bilateral hearing loss, and blindness for the past two months. Ophthalmologic examination revealed that visual acuity was 0.1 bilaterally. Conjunctival hyperemia, bilateral cataract, and interstitial keratitis were detected with a slit lamp examination. Pure tone audiogram (PTA) and auditory brain stem response (ABR) showed bilateral sensorineural hearing loss. The other differential diagnosis of CS was studied and ruled out. Pulse i.v. methylprednisolone and cyclophosphamide were given and were followed by oral prednisolone and cyclophosphamide. Clinical follow-up showed partial improvement.
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Affiliation(s)
- Ahad Azami
- Department of Internal Medicine, Imam Khomeini Hospital, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Nasrollah Maleki
- Department of Internal Medicine, Imam Khomeini Hospital, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mohammadreza Kalantar Hormozi
- Department of Endocrine and Metabolic Diseases, The Persian Gulf Tropical Medicine Research Center, Bushehr University of Medical Sciences, Bushehr 7514763448, Iran
| | - Zahra Tavosi
- Department of Internal Medicine, Shohadaye Khalije Fars Hospital, Bushehr University of Medical Sciences, Bushehr, Iran
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14
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Tayer-Shifman OE, Ilan O, Tovi H, Tal Y. Cogan's Syndrome—Clinical Guidelines and Novel Therapeutic Approaches. Clin Rev Allergy Immunol 2014; 47:65-72. [DOI: 10.1007/s12016-013-8406-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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15
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Syndromes of hearing loss associated with visual loss. Eur Arch Otorhinolaryngol 2013; 271:635-46. [DOI: 10.1007/s00405-013-2514-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 04/17/2013] [Indexed: 10/26/2022]
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16
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Queirós J, Maia S, Seca M, Friande A, Araújo M, Meireles A. Atypical Cogan's Syndrome. Case Rep Ophthalmol Med 2013; 2013:476527. [PMID: 23691387 PMCID: PMC3638509 DOI: 10.1155/2013/476527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 03/05/2013] [Indexed: 11/17/2022] Open
Abstract
Background. Cogan's syndrome is a rare clinical entity whose etiopathology is still unknown, and the treatment strategies are not clearly defined. Case. A 23-year-old male presented with symptoms of headache, peripheral facial palsy, persistent right hearing loss and bilateral papillitis. Workup excluded all infectious, granulomatous, neoplastic, and immune causes. The diagnosis of atypical Cogan's syndrome was established, and the patient was treated with systemic corticosteroids and later on with cyclophosphamide and methotrexate. There were improvement of visual symptoms and stabilisation of left hearing. Conclusion. Cogan's syndrome is a very rare disease with no specific biological tests for the diagnosis. The diagnostic exams are mostly important to exclude other etiologies. The atypical ocular and audiovestibular manifestations make the diagnosis difficult, delaying the institution of appropriate therapy which may result in profound bilateral deafness.
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Affiliation(s)
- João Queirós
- Departmento de Oftalmologia, Hospital de Santo António, Centro Hospitalar do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
| | - Sofia Maia
- Departmento de Oftalmologia, Hospital de Santo António, Centro Hospitalar do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
| | - Mariana Seca
- Departmento de Oftalmologia, Hospital de Santo António, Centro Hospitalar do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
| | - António Friande
- Departmento de Oftalmologia, Hospital de Santo António, Centro Hospitalar do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
| | - Maria Araújo
- Departmento de Oftalmologia, Hospital de Santo António, Centro Hospitalar do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
| | - Angelina Meireles
- Departmento de Oftalmologia, Hospital de Santo António, Centro Hospitalar do Porto, Largo Professor Abel Salazar, 4099-001 Porto, Portugal
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Greco A, Gallo A, Fusconi M, Magliulo G, Turchetta R, Marinelli C, Macri G, De Virgilio A, de Vincentiis M. Cogan's syndrome: An autoimmune inner ear disease. Autoimmun Rev 2013; 12:396-400. [DOI: 10.1016/j.autrev.2012.07.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 07/18/2012] [Indexed: 12/20/2022]
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20
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Abstract
Vertigo and dizziness are not independent disease entities, but instead symptoms of various diseases. Accordingly, a variety of treatment approaches are required. Here we review the most relevant drugs for managing dizziness, vertigo, and nystagmus syndromes. It is important to differentiate symptomatic treatment of nausea and vomiting with, for example, dimenhydrinate and benzodiazepines, and prophylactic treatment of motion sickness with scopolamine from a causal therapy of the underlying disorders. Examples of such causal therapy include aminopyridines for downbeat nystagmus and episodic ataxia type 2; carbamazepine for vestibular paroxysmia, paroxsymal dysarthria and ataxia in multiple sclerosis, and superior oblique myokymia; betahistine, dexamethasone, and gentamicin for Menière's disease; gabapentin and memantine for different forms of acquired and congenital nystagmus; corticosteroids for acute vestibular neuritis and Cogan's syndrome; metoprolol and topiramate for vestibular migraine; and selective serotonin reuptake inhibitors such as paroxetine for phobic postural vertigo. The clinical entities are briefly described, the various medications are discussed in alphabetical order, and dosage, major side effects, contraindications, and alternative medications of each drug are displayed in boxes for easy reference.
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Affiliation(s)
- Doreen Huppert
- Institute of Clinical Neurosciences, University of Munich, Germany.
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Reversible severe sensorineural hearing loss in a 7-year-old child (Discussion and Diagnosis). Acta Paediatr 2011. [DOI: 10.1111/j.1651-2227.2010.02051.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Scharl M, Frei P, Fried M, Rogler G, Vavricka SR. Association between Cogan's syndrome and inflammatory bowel disease: a case series. J Crohns Colitis 2011; 5:64-8. [PMID: 21272808 DOI: 10.1016/j.crohns.2010.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 09/09/2010] [Accepted: 09/09/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Cogan's syndrome (CS) is a rare autoimmune disease with less than 250 cases reported. It mainly affects the audiovestibular system and the eyes frequently resulting in deafness. Inflammatory bowel disease (IBD) consists of two subtypes, Crohn's disease (CD) and ulcerative colitis (UC), and represents a common form of chronic intestinal inflammation. Here, we report an association between CS and IBD in four patients. METHODS Patient data were collected using a questionnaire that was sent to one of our outpatients and three of the 13 members of the German CS self-help group. RESULTS In all Cogan patients with IBD (3 female with UC, 1 male with CD), intestinal disease was diagnosed years before the onset of CS. After suffering from a complicated IBD disease course, they suddenly developed CS-related symptoms, such as hearing loss, tinnitus or eye inflammation. Three of them went deaf within a few years after diagnosis. Although all of them had been on immunosuppressive IBD therapy, these treatment regimens did not prevent the onset of CS. CONCLUSIONS Our data suggest a strong association of IBD and CS. Since CS rapidly leads to bilateral deafness, it seems to be a rare, but nevertheless important disease that can occur in association with IBD. However, neither an early diagnosis nor an immunosuppressive therapy seems to efficaciously prevent disease progression.
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Affiliation(s)
- Michael Scharl
- Division of Gastroenterology and Hepatology, University Hospital Zurich, 8091 Zurich, Switzerland
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Ying YLM, Hirsch BE. Atypical Cogan's syndrome: a case report. Am J Otolaryngol 2010; 31:279-82. [PMID: 20015756 DOI: 10.1016/j.amjoto.2009.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Accepted: 02/15/2009] [Indexed: 11/25/2022]
Abstract
Cogan's syndrome is a rare presumed autoimmune disorder characterized by nonsyphilitic interstitial keratitis and progressive audiovestibular symptoms. The initial report by David G. Cogan in 1945 was modified by Haynes et al in 1980 who proposed diagnostic criteria for patients with other ocular or vestibular symptoms and suggested this to be atypical Cogan's syndrome. In a more typical presentation of Cogan's syndrome, ocular and audiovestibular signs and symptoms usually appear alone and are bilateral. We report a case of 50-year-old woman with an atypical Cogan's syndrome manifested by unusual relatively rapid clinical deterioration.
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Abstract
We report a 14-year-old boy who presented with meningoencephalitis. Other features particularly auditory, vestibular, and ocular lead to the diagnosis of Cogan's syndrome. Treatment with prednisolone resulted in a rapid improvement and recovery of his hearing. Cogan's syndrome is a rare primary vasculitis, characterized by ocular, auditory, and vestibular symptoms, which can have significant morbidity and mortality. Presentation with a meningoencephalitic picture is unusual. Increased awareness of its clinical features among pediatricians and pediatric neurologists should lead to earlier diagnosis and increased recognition of the serious systemic manifestations. Early use of prednisolone can prevent hearing loss and can also be useful in treating the other vasculitic manifestations.
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Affiliation(s)
- Karen S Pysden
- Paediatric Neurology Department, Clarendon Wing, Leeds General Infirmary, Belmont Grove, Leeds, United Kingdom.
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Son HJ, Ulualp SO. Course of auditory impairment in Cogan's syndrome. Am J Otolaryngol 2009; 30:65-8. [PMID: 19027517 DOI: 10.1016/j.amjoto.2008.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Revised: 01/14/2008] [Accepted: 02/01/2008] [Indexed: 11/16/2022]
Abstract
PURPOSE Cogan's syndrome (CS), characterized by interstitial keratitis, hearing loss, and vestibular impairment, rarely occurs in children. Hearing loss is commonly bilateral and permanent in 37%-67% of patients. To date, long-term evaluation of hearing impairment in children with CS has been reported in only 3 patients. We describe the 35-month course of hearing impairment in a teenaged boy with Cogan's syndrome. MATERIALS AND METHODS The medical record of a 15-year-old boy with Cogan's syndrome was reviewed. Data included relevant history and physical examination, diagnostic workup, and management. RESULTS The patient was diagnosed with bilateral uveitis at age 12 and was placed on oral steroid and methotrexate. He developed sudden sensorineural hearing loss, intermittent tinnitus, and no vestibular dysfunction approximately 9 months after the ophthalmic disease onset. The initial audiogram revealed mild to moderate right-sided high-frequency sensorineural hearing loss and profound left-sided sensorineural hearing loss. Steroid dosage was increased, and the patient exhibited right-side hearing improvement within 2 months. Hearing thresholds reached within normal limits on the right side at 4 months and continued to improve up to 12 months on the left side. CONCLUSIONS In a teenager with Cogan's syndrome, the severity and course of hearing impairment showed interaural differences. Improvement of hearing thresholds was slower and incomplete on the left ear. Further studies examining the course of cochleovestibular impairment in a larger group of patients with Cogan's syndrome potentially improve management and counseling.
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Affiliation(s)
- Hwa J Son
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, Texas 75390-9035, USA
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Bouchard CS. Noninfectious Keratitis. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00041-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Pherwani A, Bansal S, Agrawal S, Gillow T. Cystoid macular oedema in Cogans syndrome-a case report. CASES JOURNAL 2008; 1:339. [PMID: 19021901 PMCID: PMC2602997 DOI: 10.1186/1757-1626-1-339] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Accepted: 11/20/2008] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Cogan's Syndrome is typically characterised by a non syphilitic interstitial keratitis (IK), with or without conjunctivitis, iritis or subconjunctival bleeding and progressive sensorineural hearing loss within two years of ocular signs. Atypical ocular manifestations include episcleritis, scleritis, posterior scleritis, retinal artery occlusion, choroiditis, retinal vasculitis, and optic disc oedema. We report a case of Cogan's syndrome in with recurrent cystoid macular oedema was the main feature. CASE PRESENTATION A patient was diagnosed with Cogan's syndrome nearly 2 years after first presentation. He had cystoid macular edema which failed to respond initially to steroid, methotrexate and azothiaprine however resolved after treatment with mycophenolate mofetil. CONCLUSION Cogan's syndrome is rare and presents a challenge in terms of diagnosis and treatment. Recurrent cystoid macular oedema is a unique finding in this condition and can be difficult to control. Multidisciplinary management of this multisystem disorder is vital.
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Affiliation(s)
| | | | | | - Timothy Gillow
- North Staffordshire University Hospital, Stoke On Trent, UK
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Rosenbaum JT, Becker MD, Smith JR. Immunologic ocular disease. Clin Immunol 2008. [DOI: 10.1016/b978-0-323-04404-2.10073-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Fricker M, Baumann A, Wermelinger F, Villiger PM, Helbling A. A novel therapeutic option in Cogan diseases? TNF-alpha blockers. Rheumatol Int 2007; 27:493-5. [PMID: 17102947 DOI: 10.1007/s00296-006-0252-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2006] [Accepted: 09/28/2006] [Indexed: 10/23/2022]
Abstract
Cogan's syndrome is characterized by noninfectious, interstitial keratitis combined with a vestibulo-auditory deficit. Despite therapy with corticosteroids in combination with immunosuppressive agents, relapses occurred in two subjects and the clinical course suggested a progression of the disease. Treatment with anti-TNF-alpha was started leading to a rapid and sustained clinical remission for over 2 respectively 3 years.
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Affiliation(s)
- M Fricker
- Division of Allergology, Policlinics of Allergy and Immunology, Department of Rheumatology and Clinical Immunology/Allergology, University Hospital (Inselspital), Bern, Switzerland
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Vishwakarma R, Shawn TJ. Cochlear implant in Cogan's syndrome. Eur Arch Otorhinolaryngol 2007; 264:1121-4. [PMID: 17639443 DOI: 10.1007/s00405-007-0362-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Accepted: 05/23/2007] [Indexed: 11/26/2022]
Abstract
Post-lingual deafness is a stressful condition which is rendered even more painful by the sudden emotional isolation that the patient suffers. Cogan's syndrome is a rare autoimmune cause for post-lingual deafness characterized by non-syphilitic interstitial keratitis, bilateral audio vestibular deficiencies and systemic vasculitis. World over very few cases of Cogan's syndrome have been reported. Cochlear implant surgery in such a patient is a challenging but highly satisfactory experience due to the multitude of clinical problems the patient faces. This demands a proper work up, meticulous surgery and stringent post-operative follow-up. Here we present a patient with atypical Cogan's syndrome, diabetes mellitus and hypothyroidism. She went into a major depression with suicidal tendency following the complete loss of hearing. We performed cochlear implant surgery in this patient, but not before facing several clinical obstacles, helped by a dedicated team consisting of a rheumatologist, endocrinologist, neurophysician, psychiatrist, anaesthetists and audiologist. The results are extremely satisfying for the patient and all the people involved. This case underlines the prime importance of hearing in maintaining the psychological well being of a human being.
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Affiliation(s)
- Rajesh Vishwakarma
- Department of Otorhinolaryngology and Head and Neck Surgery, B J Medical College and Civil Hospital, Ahmedabad, India.
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Deliveliotou A, Moustakarias T, Argeitis J, Vaggos G, Vitoratos N, Hassiakos D. Successful full-term pregnancy in a woman with Cogan’s syndrome: a case report. Clin Rheumatol 2007; 26:2181-2183. [PMID: 17574494 DOI: 10.1007/s10067-007-0664-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Revised: 05/30/2007] [Accepted: 05/30/2007] [Indexed: 11/26/2022]
Abstract
Cogan's syndrome (CS) is a chronic inflammatory disorder that most commonly affects young adults. Major clinical features are interstitial keratitis and vestibuloauditory dysfunction. Associations between CS and systemic vasculitis as well as aortitis also exist. The present report is the first case in the literature of pregnancy associated with Cogan syndrome, which posed a therapeutic challenge. There was a relapse of the ocular symptoms only during the first trimester of pregnancy, but the pregnancy was otherwise uneventful. The relevant literature is reviewed both with regard to the relationship of CS to pregnancy and the therapeutic approach in this situation.
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Affiliation(s)
- Aikaterini Deliveliotou
- 2nd Department of Obstetrics and Gynaecology, University of Athens Medical School, 'Aretaieion' Hospital, 76, Vas. Sofias Avenue, 11528, Athens, Greece.
| | - Theodore Moustakarias
- 2nd Department of Obstetrics and Gynaecology, University of Athens Medical School, 'Aretaieion' Hospital, 76, Vas. Sofias Avenue, 11528, Athens, Greece
| | - John Argeitis
- 2nd Department of Obstetrics and Gynaecology, University of Athens Medical School, 'Aretaieion' Hospital, 76, Vas. Sofias Avenue, 11528, Athens, Greece
| | - George Vaggos
- 2nd Department of Obstetrics and Gynaecology, University of Athens Medical School, 'Aretaieion' Hospital, 76, Vas. Sofias Avenue, 11528, Athens, Greece
| | - Nikolaos Vitoratos
- 2nd Department of Obstetrics and Gynaecology, University of Athens Medical School, 'Aretaieion' Hospital, 76, Vas. Sofias Avenue, 11528, Athens, Greece
| | - Dimitrios Hassiakos
- 2nd Department of Obstetrics and Gynaecology, University of Athens Medical School, 'Aretaieion' Hospital, 76, Vas. Sofias Avenue, 11528, Athens, Greece
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Baumann A, Helbling A, Oertle S, Häusler R, Vibert D. Cogan?s syndrome: clinical evolution of deafness and vertigo in three patients. Eur Arch Otorhinolaryngol 2004; 262:45-9. [PMID: 15004707 DOI: 10.1007/s00405-004-0738-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2003] [Accepted: 12/11/2003] [Indexed: 10/26/2022]
Abstract
The aim of this study was to evaluate the clinical symptoms, the otoneurological examinations, the treatment and the clinical course of three patients suffering from Cogan's syndrome, a rare disease based on the clinical association of a non-syphilitic interstitial keratitis with a cochleo-vestibular deficit. This case series involved three patients with follow up. The clinical course of the three patients (aged 30, 48 and 49 years) with Cogan's syndrome during a follow-up period of 2 to 6 years is reported. All patients underwent complete otoneurological, ophthalmologic and rheumatologic examinations and were treated with immunosuppressive therapy such as glucocorticoids and cyclophosphamide in two and glucocorticoids and methotrexate in one patient. Using immunosuppressive therapy, ophthalmologic symptoms disappeared rapidly in two patients. Hearing improved only in one and stabilized in a second patient. One patient died after 6 years of treatment because of complications of generalized vasculitis. Early diagnosis and rapid initiation of a combined immunosuppressive therapy such as corticosteroids and cyclophosphamide seem to be important in controlling the disease and avoiding persistent deafness. Whether systemic complications and a fatal outcome also can be prevented is still questionable.
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Affiliation(s)
- A Baumann
- Department of ENT and Head and Neck Surgery, University Hospital Inselspital, 3010, Berne, Switzerland
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Abstract
PURPOSE To lead ophthalmologists to consider Cogan syndrome when managing a patient presenting with keratitis or other ocular inflammation accompanied by sensorineural hearing loss. METHODS Seven patients affected by Cogan syndrome were studied: two males and five females, ranging from 27 to 65 years of age (mean age: 41 years). Subjects were evaluated for a period ranging from 22 to 46 months (mean follow up time: 29.2 months). All patients were treated with immunosuppressive drug combination therapy (IDCT). RESULTS Three patients were affected by classic Cogan syndrome (i.e., vestibuloauditory symptoms and later sensorineural hearing loss and interstitial keratitis). Four patients presented atypical Cogan syndrome (i.e., sensorineural hearing loss and chronic ocular inflammation such as uveitis, scleritis, conjunctivitis, retinal vasculitis, etc.). Four of these patients had a late diagnosis. Two of them were diagnosed when they already had a cochlear implant, one with bilateral deafness underwent cochlear implantation 1 year after the beginning of IDCT, one had severe bilateral hearing loss that improved during the first year of IDCT, and then rapidly worsened to total deafness in 1 month following an episode of severe systemic hypotension. Three patients who had an early diagnosis of Cogan syndrome had no worsening of vestibuloauditory dysfunction during the follow up period. CONCLUSION Diagnosis of Cogan syndrome should not be overlooked by ophthalmologists in all patients with recurrent ocular inflammatory disease associated with vestibuloauditory symptoms. Early diagnosis is essential to commence the appropriate immunosuppressive therapy that may prevent permanent hearing loss and ocular dysfunction.
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Abstract
The clinical features, diagnosis, and treatment of systemic lupus erythematosus, scleroderma, rheumatoid arthritis, Sjögren's syndrome, mixed connective tissue disease, Behcet's disease, Cogan's syndrome, and relapsing polychondritis are reviewed from a neurological perspective with an emphasis on pathogenic mechanisms and their relationship to treatment.
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MESH Headings
- Arthritis, Rheumatoid/complications
- Arthritis, Rheumatoid/physiopathology
- Behcet Syndrome/complications
- Behcet Syndrome/diagnosis
- Brain/pathology
- Brain Diseases/complications
- Brain Diseases/diagnosis
- Brain Diseases/physiopathology
- Connective Tissue Diseases/complications
- Connective Tissue Diseases/immunology
- Connective Tissue Diseases/physiopathology
- Humans
- Incidence
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/drug therapy
- Lupus Erythematosus, Systemic/physiopathology
- Magnetic Resonance Imaging
- Polychondritis, Relapsing/complications
- Polychondritis, Relapsing/diagnosis
- Scleroderma, Systemic/complications
- Scleroderma, Systemic/drug therapy
- Scleroderma, Systemic/physiopathology
- Sjogren's Syndrome/complications
- Sjogren's Syndrome/physiopathology
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Affiliation(s)
- Stephen E Nadeau
- Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, University of Florida, College of Medicine, Gainesville, Florida 32608-1197, USA.
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Watanabe K, Nishimaki T, Yoshida M, Shinzawa J, Yoshioka R, Suzuki S, Kasukawa R. Atypical Cogan's syndrome successfully treated with corticosteroids and pulse cyclophosphamide therapy. Fukushima J Med Sci 2000; 46:49-54. [PMID: 11446378 DOI: 10.5387/fms.46.49] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
An 18-year-old woman was admitted to the medical center near her home with complaints of high fever and severe headache in June 1995. A diagnosis of adult-onset Still's disease was suspected and 50 mg/day of prednisolone was orally administered. In early April 1997, the patient suffered from sudden bilateral hearing loss and high fever. Pure tone audiogram taken at the same time showed an asymmetric bilateral neurosensorial hearing loss. A diagnosis of Cogan's syndrome was made. Administration of 60 mg prednisolone daily improved fever. Audiogram taken one month after administration of prednisolone showed improvement in the right ear. Monthly cyclophosphamide pulse therapy 700 mg combined with oral prednisolone was instituted. This combination therapy enabled the successful tapering of prednisolone without recurrence of hearing loss. Combined corticosteroid and pulse cyclophosphamide therapy would appear to be one effective regimen for Cogan's syndrome.
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Affiliation(s)
- K Watanabe
- Department of Internal Medicine II, Fukushima Medical University School of Medicine, Fukushima City, Japan
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Gran JT, Nordvåg BY, Storesund B. An overlap syndrome with features of atypical Cogan syndrome and Wegener's granulomatosis. Scand J Rheumatol 1999; 28:62-4. [PMID: 10092168 DOI: 10.1080/03009749950155823] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A 48 year old women developed serous otitis, scleritis, myalgia, vertigo, polyneuropathy, crescentic glomerulonephritis, general cerebral dysrythmia, hilar adenopathy, and retroorbital granulomatous inflammation. Pulmonary manifestations were absent and antibodies against neutrophilic cytoplasmic antigens (ANCA) could not be detected. The clinical picture was classified as an overlap syndrome with features of both atypical Cogan syndrome and Wegener's granulomatosis. The patient responded to treatment with high dose corticosteroids and pulse cyclophosphamide.
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Affiliation(s)
- J T Gran
- Department of Rheumatology, University Hospital of Tromsø, Norway
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Abstract
Work originating in the 1940s led to the characterization of a rare, chronic inflammatory disorder with a unique predilection for the cornea and vestibuloauditory apparatus, now called Cogan's syndrome (CS) after the ophthalmologist who first described it. CS occurs primarily in young adults and typically presents with interstitial keratitis (IK) and Ménière's-like episodes developing within several months of each other. The inflammatory process may target other ocular sites, and the disease itself may be accompanied by aortitis or a Takayasu's-like or medium-sized vessel vasculitis. Morbidity in CS results from deafness and complications from cardiovascular disease. Most evidence suggests that the ocular and vestibuloauditory manifestations are not a consequence of vasculitis but rather mediated by other immunologic mechanisms, possibly organ-specific autoimmunity. The cornerstone of treatment in CS is corticosteroids, topically for IK and systemically for inner ear dysfunction. Early corticosteroid therapy appears to be critical for reversing hearing loss. Cochlear implants can partially restore auditory function and have been a salvation for patients who suffer from deafness as a result of permanent cochlear damage.
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Affiliation(s)
- E W St Clair
- Division of Rheumatology, Allergy and Clinical Immunology, Duke University Medical Center, Durham, NC 27710, USA
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Cinamon U, Kronenberg J, Hildesheimer M, Taitelbaum R. Cochlear implantation in patients suffering from Cogan's syndrome. J Laryngol Otol 1997; 111:928-30. [PMID: 9425479 DOI: 10.1017/s002221510013899x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Among patients who receive cochlear implants, those with Cogan's syndrome make a unique group. On one hand they are part of the post-lingual patients and good results can be anticipated. On the other hand, their basic illness is thought to have an autoimmune aetiology and for that reason more susceptible to complications, especially flap problems. In a series of 60 patients who were implanted at the Sheba Medical Center, three had Cogan's syndrome. No post-operative complications, including flap problems, were observed (followed-up for at least 18 months). Subjective and objective hearing results were very good.
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Affiliation(s)
- U Cinamon
- Department of Otolaryngology, Head and Neck Surgery, Chaim Sheba Medical Centre, Tel-Aviv University, Sackler School of Medicine, Tel-Hashomer, Israel
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Dekker JJ, Dinant HJ, Van Soesbergen RM. Cogan's syndrome as an extra-articular manifestation of rheumatoid arthritis. Clin Rheumatol 1996; 15:374-7. [PMID: 8853171 DOI: 10.1007/bf02230360] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- J J Dekker
- Department of Rheumatology, Slotervaartziekenhuis, Amsterdam, The Netherlands
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Richardson B. Methotrexate therapy for hearing loss in Cogan's syndrome. ARTHRITIS AND RHEUMATISM 1994; 37:1559-61. [PMID: 7945486 DOI: 10.1002/art.1780371026] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Vaiopoulos G, Sfikakis PP, Skoumas B, Kavouklis E, Doukas E, Kaklamanis P. Lack of response to corticosteroids and pulse cyclophosphamide therapy in Cogan's syndrome. Clin Rheumatol 1994; 13:110-2. [PMID: 8187429 DOI: 10.1007/bf02229876] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A 17-year-old girl with Cogan's syndrome is described. Total and irreversible hearing loss occurred which was unresponsive to corticosteroids and immunosuppressive therapy. The girl died a year later from subarachnoid haemorrhage. The lethal prognosis in Cogan's syndrome despite the available treatment is emphasized.
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Affiliation(s)
- G Vaiopoulos
- Department of Internal Medicine, University of Athens School of Medicine, Laiko General Hospital, Greece
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