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Ramani PK, Grigorian F, Lightle H, Joshi SV. Paediatric Cogan Syndrome masquerading as IgA vasculitis. Mod Rheumatol Case Rep 2023; 8:229-236. [PMID: 37902167 DOI: 10.1093/mrcr/rxad060] [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: 06/01/2023] [Revised: 08/18/2023] [Accepted: 10/16/2023] [Indexed: 10/31/2023]
Abstract
Paediatric Cogan Syndrome is a rare and underrecognised autoimmune vasculitis characterised by ocular inflammation and sensorineural hearing loss. Its etiopathogenesis, diagnosis, and management are not well defined. We report a 12-year-old girl who initially presented with symptoms of IgA vasculitis formerly called Henoch Schoenlein Purpura (HSP) and eventually developed anterior uveitis and bilateral sensorineural hearing loss leading to the diagnosis of atypical Cogan Syndrome. The workup for infectious etiologies and other systemic rheumatologic disorders was negative. The management was multidisciplinary involving Rheumatology, Ophthalmology, Otorhinolaryngology, and Audiology. The anterior uveitis responded well to systemic glucocorticoids and Methotrexate, but the hearing loss was grossly progressive warranting a cochlear implant. We are not aware of Paediatric Cogan Syndrome being reported as a mimicker of IgA vasculitis previously in the literature. It is an important finding as IgA vasculitis is prevalent in the paediatric age group and new-onset ocular or vestibular symptoms after IgA vasculitis should alert the clinician to the possibility of Cogan Syndrome. In the absence of well-defined diagnostic criteria, it is crucial to recognise the clinical symptoms of Paediatric Cogan Syndrome for early diagnosis and treatment since the delay in diagnosis can lead to permanent disability.
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Affiliation(s)
- Praveen K Ramani
- Department of Pediatric Neurology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Florin Grigorian
- Department of Ophthalmology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Heidi Lightle
- Department of Audiology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Saumya V Joshi
- Department of Pediatrics, Division of Pediatric Rheumatology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Psillas G, Dimas GG, Savopoulos C, Constantinidis J. Autoimmune Hearing Loss: A Diagnostic Challenge. J Clin Med 2022; 11:jcm11154601. [PMID: 35956215 PMCID: PMC9369521 DOI: 10.3390/jcm11154601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- George Psillas
- 1st Otolaryngology Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece
- Correspondence: ; Tel.: +30-2310-994-762; Fax: +30-2310-994-916
| | - Grigorios George Dimas
- 1st Propedeutic Department of Internal Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece
| | - Christos Savopoulos
- 1st Propedeutic Department of Internal Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece
| | - Jiannis Constantinidis
- 1st Otolaryngology Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, 54636 Thessaloniki, Greece
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Lee B, Bae YJ, Choi BY, Kim YS, Han JH, Kim H, Choi BS, Kim JH. Construction of an MRI-based decision tree to differentiate autoimmune and autoinflammatory inner ear disease from chronic otitis media with sensorineural hearing loss. Sci Rep 2021; 11:19171. [PMID: 34580346 PMCID: PMC8476614 DOI: 10.1038/s41598-021-98557-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/09/2021] [Indexed: 12/05/2022] Open
Abstract
Autoimmune and autoinflammatory inner ear diseases (AIED/AID) are characterized by the symptom of sensorineural hearing loss (SNHL). To date, standardized diagnostic tools for AIED/AID are lacking, and clinically differentiating AIED/AID from chronic otitis media (COM) with SNHL is challenging. This retrospective study aimed to construct a magnetic resonance imaging (MRI)-based decision tree using classification and regression tree (CART) analysis to distinguish AIED/AID from COM. In total, 67 patients were enrolled between January 2004 and October 2019, comprising AIED/AID (n = 18), COM (n = 24), and control groups (n = 25). All patients underwent 3 T temporal bone MRI, including post-contrast T1-weighted images (postT1WI) and post-contrast FLAIR images (postFLAIR). Two radiologists evaluated the presence of otomastoid effusion and inner ear contrast-enhancement on MRI. A CART decision tree model was constructed using MRI features to differentiate AIED/AID from COM and control groups, and diagnostic performance was analyzed. High-intensity bilateral effusion (61.1%) and inner ear enhancement (postFLAIR, 93.8%; postT1WI, 61.1%) were the most common findings in the AIED/AID group. We constructed two CART decision tree models; the first used effusion amount as the first partitioning node and postT1WI-inner ear enhancement as the second node, whereas the second comprised two partitioning nodes with the degree of postFLAIR-enhancement of the inner ear. The first and second models enabled distinction of AIED/AID from COM with high specificity (100% and 94.3%, respectively). The amount of effusion and the degree of inner ear enhancement on MRI may facilitate the distinction between AIED/AID and COM with SNHL using decision tree models, thereby contributing to early diagnosis and intervention.
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Affiliation(s)
- Boeun Lee
- Department of Radiology, College of Medicine, Ewha Womans University, Ewha Womans University Seoul Hospital, 260, Gonghang-daero, Gangseo-gu, Seoul, 07804, Republic of Korea
| | - Yun Jung Bae
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea.
| | - Byung Yoon Choi
- Department of Otolaryngology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea.
| | - Young Seok Kim
- Department of Otolaryngology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea
| | - Jin Hee Han
- Department of Otolaryngology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea
| | - Hyojin Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Republic of Korea
| | - Byung Se Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea
| | - Jae Hyoung Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, 13620, Republic of Korea
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Topaloğlu Ö, Şahin B. Hearing Impairment and Audiological Alterations in Euthyroid Hashimoto's Thyroiditis. ORL J Otorhinolaryngol Relat Spec 2021; 84:238-246. [PMID: 34515191 DOI: 10.1159/000517931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 06/13/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Hearing loss may be associated with autoimmune diseases, but it was less studied in Hashimoto's thyroiditis (HT). We aimed to evaluate hearing impairment and audiological alterations in adults with euthyroid HT. METHODS Adult patients with euthyroid HT (normal thyroid functions, positive antithyroid peroxidase (anti-TPO)/anti-thyroglobulin, and sonographic findings) were compared with controls. We excluded pregnant or older patients (>40 years), those with a history of otological/audiological disease or surgery, otitis media, acoustic trauma, chronic illnesses, use of alcohol, cigarette, medications, rheumatoid factor, antinuclear, antimitochondrial, antiparietal, antineutrophil cytoplasmic, anti-smooth muscle, or antigliadin antibodies, abnormal biochemical or otological findings. Tympanometry which indicates tympanic peak pressure (TPP, daPa), acoustic reflex testing (ART), pure-tone average (PTA), and transient evoked otoacoustic emission (TEOAE) were performed. We grouped the participants according to ART (positive/negative), TEOAE (normal/undetected), and PTA (≤20/>20 decibel). RESULTS Air conduction thresholds on the right ear at 500, 4,000, 6,000, and 8,000 Hz, PTA, and the left ear at 250, 4,000, 6,000, and 8,000 Hz were higher in euthyroid HT (n = 36) than in controls (n = 40) (p < 0.05). We found less negative TPP and a higher ratio of negative ART in euthyroid HT (p < 0.05). Euthyroid HT predicted undetected TEOAE and increased hearing threshold on the right ear at 500 and 8,000 Hz (p < 0.001). TEOAE detected audiological abnormality at a higher rate. Anti-TPO was positively correlated with TPP and air conduction thresholds, except the right ear at 8,000 Hz. DISCUSSION/CONCLUSION Hearing and audiological tests may be impaired in euthyroid HT. We recommend close monitoring of audiological functions in these patients. TE-OAE more specifically indicates audiological abnormality.
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Affiliation(s)
- Ömercan Topaloğlu
- Endocrinology Clinics, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Bayram Şahin
- Otorhinolaryngology & Head and Neck Surgery Clinics, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
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Guerra J, Devesa J. Causes and treatment of idiopathic benign paroxysmal positional vertigo based on endocrinological and other metabolic factors. J Otol 2020; 15:155-160. [PMID: 33293917 PMCID: PMC7691829 DOI: 10.1016/j.joto.2020.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 04/07/2020] [Accepted: 04/12/2020] [Indexed: 12/21/2022] Open
Abstract
The genesis of the Benign Paroxysmal Positional Vertigo (BPPV) seems to be related to some metabolic factors. These factors, such as vitamin D, glucocorticoids, and even thyroid and growth hormones, can affect bone metabolism and the mineralization of otoconia. It also seems to link to factors related to aging or nutritional habits. Besides, since the incidence of BPPV is quantitatively higher in women than in men, female sex steroids could be associated with this process. It could be useful to understand how these factors act in otoconial mineralization if we want to develop treatments aimed at preventing or delaying BPPV recurrences. In this review, we will analyze the role of these metabolic and hormonal factors in otoconial mineralization and in the treatment of BPPV.
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Affiliation(s)
- Joaquín Guerra
- Otolaryngology, Medical Center Foltra, Travesía de Montouto 24, 15886, Teo, Spain
- Corresponding author. Medical Center Foltra, Travesía de Montouto 24, 15886, Teo, Spain.
| | - Jesús Devesa
- Scientific Direction, Medical Center Foltra, Travesía de Montouto 24, 15886, Teo, Spain
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Chiarello P, Talarico V, Nicoletti A, Rodio B, Arcuri PP, Bosco D, Gigliotti F, Galati MC, Raiola G. Hashimoto encephalopathy: a case report and a short revision of current literature. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020087. [PMID: 32921783 PMCID: PMC7717026 DOI: 10.23750/abm.v91i3.10157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 11/24/2022]
Abstract
Hashimoto encephalopathy (HE) is a rare but controversial entity encompassing a variety of neuropsychological presentations in the setting of autoimmune thyroid disease. HE, mostly described in adults, with a female‑to‑male ratio of 4:1, is a relatively rare entity in the pediatric population and probably under recognized as a cause of acute encephalopathy in children and adolescents. A number of pathogenetic mechanisms have been suggested. Female prevalence, presence of autoantibodies, fluctuating course, and response to immunomodulatory therapy suggest the autoimmune nature of the disease. Existing diagnostic criteria for adults require modification to be applied to children and adolescents, who differ from adults in their clinical presentations, clinical findings, autoantibody profiles, treatment response, and long-term outcomes. A combination of neurological findings, positive antithyroid autoantibodies, and responsiveness to steroids is diagnostic of HE. We add a new case of HE in an adolescent girl and review the current HE literature.
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Affiliation(s)
- Paola Chiarello
- Department of Pediatrics, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | | | - Angela Nicoletti
- Department of Pediatrics, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | | | - Pier Paolo Arcuri
- Department of Radiology, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Domenico Bosco
- Department of Neurology, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Francesco Gigliotti
- Department of Pediatric Oncohematology, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | | | - Giuseppe Raiola
- Department of Pediatrics, Pugliese-Ciaccio Hospital, Catanzaro, Italy
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