Cogan syndrome is a rare autoimmune disease involving the eye and the inner ear.
Cogan syndrome affects young adults, with 80% of patients between 14 and 47 years. The disease appears to result from an autoimmune reaction directed against an unknown common autoantigen in the cornea and inner ear. About 10 to 30% of patients also have severe systemic vasculitis, which may include life-threatening aortitis.
Symptoms and Signs of Cogan Syndrome
The presenting symptoms involve the ocular system in 38% of patients, the vestibuloauditory system in 46%, and both in 15%. By 5 months, 75% of patients have both ocular and vestibuloauditory symptoms. Nonspecific systemic complaints include fever, headache, joint pain, and myalgia.
Очний
Ocular involvement includes any combination of the following:
Bilateral interstitial keratitis or other corneal stromal keratitis
Papillitis
Other orbital inflammation (eg, vitritis, choroiditis)
Ocular symptoms include irritation, pain, photophobia, and decreased vision. Ocular examination shows a patchy corneal stromal infiltrate typical of interstitial keratitis, ocular redness, optic nerve edema, proptosis, or a combination of these symptoms.
Вестибулослуховий
Vestibuloauditory symptoms can include sensorineural hearing loss, tinnitus, vertigo, and/or a sensation of fullness or pressure.
Судинний
A diastolic heart murmur may be present when aortitis is significant. Claudication may be present if limb vessels are affected.
Diagnosis of Cogan Syndrome
Clinical evaluation
Urgent evaluation by an ophthalmologist and otolaryngologist is indicated when Cogan syndrome is suspected. Diagnosis is based on clinical findings and exclusion of other causes of stromal keratitis (eg, syphilis, Lyme disease, Epstein-Barr virus infection) by appropriate serologic tests. Antibodies to inner ear antigens, anti-Hsp70 (associated with sensorineural hearing loss), and antineutrophil cytoplasmic antibodies (associated with vasculitis) have been found in patients with Cogan syndrome. CT and MRI should be done and may be normal or demonstrate labyrinthitis, inflammation, or calcification of the semicircular canals, vestibule, or cochlea.
Treatment of Cogan Syndrome
Initially topical and sometimes systemic corticosteroids for ocular involvement
Untreated disease may lead to corneal scarring and vision loss and, in 60 to 80% of patients, permanent hearing loss. Keratitis (and symptoms of corneal involvement), episcleritis, and anterior uveitis can usually be treated with topical prednisolone acetate 1%, 1 drop 4 times daily up to once every hour while awake, for 2 to 3 weeks. To treat deeper ocular inflammation and to treat vestibuloauditory symptoms before they become permanent, prednisone 1 mg/kg orally once a day is begun as soon as possible and continued for 2 to 6 months. Some clinicians add cyclophosphamide, methotrexate, cyclosporine, infliximab, or rituximab for recalcitrant cases.
Ключові моменти
Cogan syndrome is a rare autoimmune syndrome affecting mainly the ocular and vestibuloauditory systems.
Life-threatening aortitis sometimes occurs.
If untreated, permanent vision and hearing loss can result.
Urgent evaluation by an ophthalmologist and otolaryngologist is indicated.
Treatment is typically with corticosteroids (topical and systemic).
