Cogan’s Syndrome: Much More Than Red Eyes and Dizziness

Meeting: Hospital Medicine 2012

Abstract number: 97902

Case Presentation:

A 37–year–old male with benign past medical history presented with worsening bilateral conjunctival injection, progressive hearing impairment and disequilibrium for approximately 1 month. He had earlier been on erythromycin eye drops for suspected pink eye. The conjunctivitis worsened even after his ocular antibiotic eye drops were changed to tobramycin. One week later, he became unsteady on his feet and dizzy. He was seen by at a Neurology clinic and started on Meclizine. Two weeks later he admitted because of the progression of his ocular symptoms, disequilibrium and onset of hearing impairment. Physical Exam: Afebrile, BP– 124/68. HR–68. He had obvious hearing impairment and was therefore speaking clearly and fluently in a loud voice. HEENT: Bilateral conjunctival injection. Extensive tearing hazy corneas, left greater than right. Pupils sluggish but reactive. Hearing: Bone conduction greater than ear conduction in both ears. CNS: Cranial nerves II to XII intact. Strength and sensory modalities were normal in four extremities. He had no nystagmus or dysmetria. Wide– based ataxic gait and positive Romberg’s sign. Labs: CBC and SMA–7 were normal. CRP: 22.8 and ESR: 37. HIV serology and RPR were negative. His Brain MRI was unremarkable.

Discussion:

Slit–lamp evaluation by ophthalmology revealed he had interstitial keratitis. Audiology evaluation showed moderate to severe hearing loss in the right ear and severe loss of hearing in the left ear. Based on the constellation of his symptoms he was diagnosed with Cogan’s syndrome. He was initially treated with IV Solu–medrol and then transitioned to Prednisone. He was also given prednisolone 1% eye drops and homatropine 5% eye drops. At the time of discharge the patient had a normal gait and his vision and disequilibrium had significantly improved. Cogan’s syndrome: David Cogan described this condition in 1945. This is a chronic inflammatory disorder, which mainly affects young adults. Although there may be evidence of autoimmunity, the exact etiology is unknown. The clinical hallmarks are non–syphilitic interstitial keratitis, and vestibuloauditory dysfunction.

Conclusions:

Diagnosis requires a high index of suspicion. Evaluation by ophthalmology, Neurology and/or Otology and Rheumatology are required to establish this diagnosis. The anti–68–kd antigen (HSP 70) is neither specific nor sensitive test for Cogan’s syndrome. Differential diagnosis includes Viral and Chlamydial infections, and sarcoidosis. Treatment includes the use of topical agents for limited ocular disease and immunosuppressive therapy for more extensive ocular disease, inner ear involvement and/or systemic vasculitis. Hospitalists need to be aware of this condition because of its debilitating effects if not diagnosed and treated appropriately and also because of its association with aortitis in about 10% of patients. Aortitis has been characterized by proximal aorta dilation, aortic valvular regurgitation and ostial coronary artery disease.

To cite this abstract:

Dapaah–Afriyie K. Cogan’s Syndrome: Much More Than Red Eyes and Dizziness. Abstract published at Hospital Medicine 2012 Abstract 97902. https://www.shmabstracts.com/abstract/cogans-syndrome-much-more-than-red-eyes-and-dizziness/. Accessed November 17, 2018.

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