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Chen Y, Hu J, Wu D, Wu T, Zhu J. Tocilizumab Successfully Treating Refractory Hearing Impairment in a Patient With Cogan Syndrome: A Case Report and Review of the Literature. EAR, NOSE & THROAT JOURNAL 2024:1455613241237079. [PMID: 38494750 DOI: 10.1177/01455613241237079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Cogan syndrome (CS) is a rare systemic vasculitis characterized primarily by nonsyphilitic interstitial keratitis and vestibular and auditory dysfunction. In this article, we report the case of a 31-year-old male diagnosed with CS for 1 year. He was admitted to the hospital with fever, dizziness, headache, tinnitus, and hearing loss. After being treated with glucocorticoids, cellular immunosuppressants, and infliximab therapy, his symptoms were greatly relieved except for hearing loss. Then, he attempted to use tocilizumab (TCZ) which was ultimately effective in controlling the auditory dysfunction. In addition, we found 4 cases of TCZ for CS through a literature review and compared them with our patient. Although glucocorticoids are still the first-line treatment for CS, TCZ therapy provides fresh hope for patients who have refractory hearing impairment with hormone resistance, or whose hormone dosages cannot be lowered to maintenance levels.
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Affiliation(s)
- Yan Chen
- Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Rheumatology and Immunology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Jiarui Hu
- Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Nephrology, Chengdu Jinniu District People's Hospital, Chengdu, China
| | - Dongze Wu
- Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Rheumatology and Immunology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Tong Wu
- Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Rheumatology and Immunology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Jing Zhu
- Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Department of Rheumatology and Immunology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
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Aldajani NF, Aloufi AM, Binhudayb NA, Yahya BJ, Alkarni AF. Approach to Sudden Hearing Loss Among Primary Care Physicians in Riyadh, Saudi Arabia. Cureus 2024; 16:e55849. [PMID: 38463405 PMCID: PMC10924649 DOI: 10.7759/cureus.55849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 03/12/2024] Open
Abstract
INTRODUCTION A medical emergency known as sudden sensorineural hearing loss (SSNHL) affects the ears suddenly, has a considerable probability of negative cognitive and functional outcomes, and can influence the patient's quality of life. Primary care physicians play a crucial role in diagnosing SSNHL and initiating prompt and efficient management since they are the ones who would likely encounter it initially. This study aims to evaluate the present knowledge, diagnostic, and management perspective of SSNHL among primary care physicians in Riyadh, Saudi Arabia. METHODS A self-generated questionnaire with 17 questions was developed, and a link to the online survey was delivered to primary care physicians (PHPs) in Riyadh, Saudi Arabia, concerning the management of SSNHL. RESULTS The knowledge level regarding SSNHL was evaluated, in which 21 (25%) of the participants had a low knowledge level, 34 (40.5%) had moderate knowledge, and 29 (34.5%) had a high knowledge level. Among 84 participants, 20 (23.8%) were confident in their ability to administer and understand the findings of tuning fork tests (TFT) to differentiate between sensorineural hearing loss and conductive hearing loss, whereas 64 (76.2%) were unsure about it. In addition, to distinguish between sensorineural hearing loss and conductive hearing loss, 62 (73.8%) participants were confident, and 22 (26.2%) participants were skeptical about their ability to interpret a formal audiogram. CONCLUSION Considering SSNHL as a medical emergency, in our survey, many family doctors would make proper referral and treatment decisions. However, TFTs were underutilized for guiding management decisions compared to other ways to distinguish between conductive and sensorineural hearing loss.
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Affiliation(s)
- Nader F Aldajani
- Otolaryngology-Head and Neck Surgery, King Fahad Medical City, Riyadh, SAU
| | | | - Nujud A Binhudayb
- Clinical Sciences, College of Medicine-Almaarefa University, Riyadh, SAU
| | - Buthaina J Yahya
- Otolaryngology-Head and Neck Surgery, King Fahad Medical City, Riyadh, SAU
| | - Abdullah F Alkarni
- Otolaryngology-Head and Neck Surgery, King Abdulaziz Medical City Riyadh, Riyadh, SAU
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3
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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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Samarrai R, Rahman K, Parham K. Clinical Biomarkers in Otolaryngology-Head and Neck Surgery: Autoimmune Diseases. EAR, NOSE & THROAT JOURNAL 2024; 103:29-35. [PMID: 34281418 DOI: 10.1177/01455613211033121] [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] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The purpose of this article is to review the literature and compile promising and clinically relevant biomarkers in autoimmune disease related to otolaryngology-head and neck surgery. STUDY DESIGN Narrative review. METHODS Pubmed and Google Scholar were queried using combined key words such as "biomarkers" and "otolaryngology." Additional queries were made with combined key words such as "biomarkers" and a particular subspecialty such as "autoimmune" or "Meniere's" to maximize yield of relevant titles. Subsequently, specific biomarkers identified, such as "anti-TPO-antibodies," were used as key words. Relevant titles were reviewed and selected for abstract review. Applicable abstracts were then selected for review of the full text. RESULTS Biomarkers that are currently in clinical use for the management of autoimmune diseases within the field of otolaryngology were included in this review. The compiled biomarkers were then detailed individually regarding their molecular characteristics, function, and clinical significance. CONCLUSIONS Based on this literature review, there are several biomarkers currently in clinical use within the field of otolaryngology relating to autoimmune diseases. The majority of these biomarkers are in the form of proteins such as Cogan peptide and c-ANCA. This survey may serve as a comprehensive resource on biomarkers for autoimmune diseases in clinical otolaryngology.
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Affiliation(s)
- Ruwaa Samarrai
- Department of Otolaryngology-Head and Neck Surgery, University of Connecticut Health Center, Farmington, CT, USA
| | - Khalil Rahman
- Department of Otolaryngology-Head and Neck Surgery, University of Connecticut Health Center, Farmington, CT, USA
| | - Kourosh Parham
- Department of Otolaryngology-Head and Neck Surgery, University of Connecticut Health Center, Farmington, CT, USA
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Rücklová K, von Kalle T, Koitschev A, Gekeler K, Scheltdorf M, Heinkele A, Blankenburg F, Kötter I, Hospach A. Paediatric Cogan´s syndrome - review of literature, case report and practical approach to diagnosis and management. Pediatr Rheumatol Online J 2023; 21:54. [PMID: 37291629 DOI: 10.1186/s12969-023-00830-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/14/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Cogan´s syndrome is a rare, presumed autoimmune vasculitis of various vessels characterized by interstitial keratitis and vestibular impairment accompanied by sensorineural hearing loss. Due to the rarity of Cogan´s syndrome in children, therapeutic decision making may be challenging. Therefore, a literature search was performed to collect all published paediatric Cogan´s syndrome cases with their clinical characteristics, disease course, treatment modalities used and their outcome. The cohort was supplemented with our own patient. MAIN TEXT Altogether, 55 paediatric Cogan´s syndrome patients aged median 12 years have been reported so far. These were identified in PubMed with the keywords "Cogan´s syndrome" and "children" or "childhood". All patients suffered from inflammatory ocular and vestibulo-auditory symptoms. In addition, 32/55 (58%) manifested systemic symptoms with musculoskeletal involvement being the most common with a prevalence of 45%, followed by neurological and skin manifestations. Aortitis was detected in 9/55 (16%). Regarding prognosis, remission in ocular symptoms was attained in 69%, whereas only 32% achieved a significant improvement in auditory function. Mortality was 2/55. Our patient was an 8 year old girl who presented with bilateral uveitis and a history of long standing hearing deficit. She also complained of intermittent vertigo, subfebrile temperatures, abdominal pain with diarrhoea, fatigue and recurrent epistaxis. The diagnosis was supported by bilateral labyrinthitis seen on contrast-enhanced magnetic resonance imaging. Treatment with topical and systemic steroids was started immediately. As the effect on auditory function was only transient, infliximab was added early in the disease course. This led to a remission of ocular and systemic symptoms and a normalization of hearing in the right ear. Her left ear remained deaf and the girl is currently evaluated for a unilateral cochlear implantation. CONCLUSIONS This study presents an analysis of the largest cohort of paediatric Cogan´s syndrome patients. Based on the collected data, the first practical guide to a diagnostic work-up and treatment in children with Cogan´s syndrome is provided.
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Affiliation(s)
- Kristina Rücklová
- Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany.
- Third Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Thekla von Kalle
- Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Assen Koitschev
- Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | - Katrin Gekeler
- Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | | | - Anita Heinkele
- Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
| | | | - Ina Kötter
- University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Clinic for Rheumatology and Immunology Bad Bramstedt, Bad Bramstedt, Germany
| | - Anton Hospach
- Klinikum Stuttgart, Kriegsbergstraße 60, 70174, Stuttgart, Germany
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Wang Y, Tang S, Shao C, Liu Y. Cogan's syndrome is more than just keratitis: a case-based literature review. BMC Ophthalmol 2023; 23:212. [PMID: 37173630 PMCID: PMC10176949 DOI: 10.1186/s12886-023-02966-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Cogan's syndrome (CS) is a rare autoimmune disorder characterized by non-syphilitic interstitial keratitis (IK) and Menière-like cochlear vestibular symptoms, which may also have systemic effects. Corticosteroids are first-line treatment. DMARDs and biologics have been used to treat ocular and systemic symptoms of CS. CASE PRESENTATION This is a case of a 35-year-old female who reported hearing loss, eye redness and photophobia. Her condition progressed to a sudden sensorineural hearing loss, tinnitus, and constant vertigo accompanied by cephalea. CS was diagnosed after excluding other diseases. The patient still developed bilateral sensorineural hearing loss after receiving hormone, methotrexate, cyclophosphamide, and a variety of biological agents. Joint symptoms were relieved after treatment with a JAK inhibitor (tofacitinib), and hearing did not deteriorate further. CONCLUSIONS CS should be involved in the differential diagnosis of keratitis. Early identification and intervention of this autoimmune disease can minimize disability and irreversible damage.
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Affiliation(s)
- Yanqing Wang
- Department of Rheumatology and Immunology, Tongren Hospital, Shanghai JiaoTong University School of Medicine, No. 1111 Xianxia Road, Changning District, Shanghai, 200336, China
| | - Shichao Tang
- Department of Rheumatology and Immunology, Tongren Hospital, Shanghai JiaoTong University School of Medicine, No. 1111 Xianxia Road, Changning District, Shanghai, 200336, China
| | - Chong Shao
- Department of Rheumatology and Immunology, Tongren Hospital, Shanghai JiaoTong University School of Medicine, No. 1111 Xianxia Road, Changning District, Shanghai, 200336, China
| | - Yu Liu
- Department of Rheumatology and Immunology, Tongren Hospital, Shanghai JiaoTong University School of Medicine, No. 1111 Xianxia Road, Changning District, Shanghai, 200336, China.
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Kasap Cuceoglu M, Basaran O, Batu ED, Kaya Akca U, Atalay E, Sener S, Balik Z, Bayindir Y, Aliyev E, Gocmen R, Kadayifcilar S, Akyol U, Bilginer Y, Ozen S. Report of 2 pediatric cases with atypical Cogan's syndrome and a systematic review. Int J Rheum Dis 2023; 26:544-550. [PMID: 36502531 DOI: 10.1111/1756-185x.14531] [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: 06/20/2022] [Revised: 11/17/2022] [Accepted: 11/26/2022] [Indexed: 12/14/2022]
Abstract
Cogan's syndrome (CS) is a rare inflammatory disease characterized by interstitial keratitis or uveitis, vestibular impairment, and progressive hearing loss, commonly bilateral. Although glucocorticoids are fundamental treatment options, in most cases, hearing loss gradually worsens. Herein we report 2 pediatric cases of CS who were treated with corticosteroids and methotrexate. One patient had a cochlear implant, and the hearing of the other patient improved with treatment. Also, a systematic literature review was conducted for articles including pediatric CS patients. In the literature, 34 articles describing 44 pediatric patients with CS were identified. Sudden hearing loss (95.3%) and ocular symptoms (92.5%) were the most common manifestations in these patients. Also, aortic involvement was present in 19.5% of patients in the literature. Otorhinolaryngologists, ophthalmologists, and pediatricians should collaborate to diagnose and manage CS to prevent progressive hearing loss and eye involvement.
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Affiliation(s)
| | - Ozge Basaran
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Ezgi Deniz Batu
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Ummusen Kaya Akca
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Erdal Atalay
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Seher Sener
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Zeynep Balik
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Yagmur Bayindir
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Emil Aliyev
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Rahsan Gocmen
- Section of Neuroradiology, Department of Radiology, Hacettepe University, Ankara, Turkey
| | | | - Umut Akyol
- Department of Otolaryngology, Hacettepe University, Ankara, Turkey
| | - Yelda Bilginer
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
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8
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Hu J, Du H, Su J, Wu T, Wu R, Zhu J. Intrathecal injection of methotrexate combined with dexamethasone for Cogan's syndrome with neurological involvement: A case report and literature review. Int J Rheum Dis 2023; 26:786-788. [PMID: 36602160 DOI: 10.1111/1756-185x.14518] [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: 06/10/2022] [Revised: 11/03/2022] [Accepted: 11/22/2022] [Indexed: 01/06/2023]
Abstract
Cogan's syndrome (CS) is a rare autoimmune disease in which approximately 10%-13% of people with the condition develop neurological symptoms. While glucocorticoids are the standard of care for patients with CS, disease-modifying anti-rheumatic drugs (DMARDs) and biologics agents are more widely used to treat the systemic and vestibular auditory manifestations of CS. Herein, we report a rare case of CS with central nervous system damage who failed to respond to systemic use of glucocorticoids and DMARDs. However, his symptoms were successfully improved by intrathecal injection of methotrexate (MTX) and dexamethasone. To our knowledge, the use of intrathecal injections of MTX and dexamethasone to treat CS has not been reported in any literature. Therefore, the present case may provide a new idea for clinicians to treat central nervous system symptoms in patients with CS.
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Affiliation(s)
- Jiarui Hu
- Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.,Department of Rheumatology and Immunology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Hongjia Du
- Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.,Department of Rheumatology and Immunology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Jiang Su
- Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.,Department of Rheumatology and Immunology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Tong Wu
- Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.,Department of Rheumatology and Immunology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Rui Wu
- Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.,Department of Rheumatology and Immunology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
| | - Jing Zhu
- Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.,Department of Rheumatology and Immunology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, China
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Álvarez Montero OL, Rodríguez Valiente A, Górriz Gil C, García Berrocal JR. Audiological evaluation (128-20,000Hz) in women with autoimmune thyroiditis: The role of antibodies vs. l-thyroxine deficiency. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2023; 74:50-58. [PMID: 36709799 DOI: 10.1016/j.otoeng.2021.11.005] [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: 03/17/2021] [Accepted: 11/29/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND AIM Although sensorineural hearing loss may have different aetiologies, we focused on autoimmune hearing loss since it may be reversible with corticosteroid therapy; this entity is sometimes associated with systemic autoimmune diseases. Hashimoto's thyroiditis or chronic autoimmune thyroiditis shows antibodies and may be harmful to hearing thresholds regardless of hypothyroidism effect. To date this effect has not been sufficiently studied and never with extended high frequencies. The aim of this work is to study by age groups whether hearing thresholds in the human auditory range (128-20,000Hz) are affected in Hashimoto's disease. MATERIALS AND METHODS Two groups of 128 patients affected by Hashimoto's thyroiditis were included. First group: patients with pathological antithyroid antibodies who do not need L-thyroxine treatment. Second group: patients controlled with L-thyroxine substitutive treatment. Audiometric threshold study comparing between the groups of patients and a group of 209 controls was performed. All patients underwent complete otorhinolaryngological examination, antithyroid antibodies, TSH, T3 and T4 blood levels, tympanometry, conventional pure-tone audiometry, and extended-high-frequency audiometry. RESULTS All patients were women. Both groups showed worst audiometric thresholds than the control group; both study groups showed worse hearing than controls, this difference was statistically significant in all frequencies. In the 8-20kHz frequency range, this difference was more than 10dB, and in the 9-16kHz and 20kHz range this difference was more than 20dB. When separated by age groups, in younger subjects (20-29 years) these differences were found in all frequencies, except for conversational frequencies (500-4,000Hz); between 30 and 49 years the difference is statistically significant in all frequencies; and from 50 to 69 years differences are found, especially in the conversational frequencies. CONCLUSIONS This first work studying the human auditory range in the chronic autoimmune thyroiditis or Hashimoto's thyroiditis confirms that hearing loss related to the autoimmune disorder predominates at extended-high-frequencies initially. But ends up involving all frequencies in pure-tone conventional audiometry, then it may be detected in routine clinical tests. These results support the role of extended-high-frequencies audiometry to diagnose subclinical hearing loss in patients affected by Hashimoto's thyroiditis.
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Affiliation(s)
| | | | - Carmen Górriz Gil
- Servicio de Otorrinolaringología, Hospital Universitario Puerta de Hierro, Madrid, Spain
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10
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Miwa T, Okano T. Role of Inner Ear Macrophages and Autoimmune/Autoinflammatory Mechanisms in the Pathophysiology of Inner Ear Disease. Front Neurol 2022; 13:861992. [PMID: 35463143 PMCID: PMC9019483 DOI: 10.3389/fneur.2022.861992] [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: 01/25/2022] [Accepted: 03/02/2022] [Indexed: 12/02/2022] Open
Abstract
Macrophages play important roles in tissue homeostasis and inflammation. Recent studies have revealed that macrophages are dispersed in the inner ear and may play essential roles in eliciting an immune response. Autoinflammatory diseases comprise a family of immune-mediated diseases, some of which involve sensorineural hearing loss, indicating that similar mechanisms may underlie the pathogenesis of immune-mediated hearing loss. Autoimmune inner ear disease (AIED) is an idiopathic disorder characterized by unexpected hearing loss. Tissue macrophages in the inner ear represent a potential target for modulation of the local immune response in patients with AIED/autoinflammatory diseases. In this review, we describe the relationship between cochlear macrophages and the pathophysiology of AIED/autoinflammatory disease.
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Affiliation(s)
- Toru Miwa
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Otolaryngology-Head and Neck Surgery, Tazuke Kofukai Medical Research Institute Kitano Hospital, Osaka, Japan
- *Correspondence: Toru Miwa
| | - Takayuki Okano
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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11
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Álvarez Montero OL, Rodríguez Valiente A, Górriz Gil C, García Berrocal JR. Estudio de la audición (128-20.000 Hz) en mujeres con tiroiditis autoinmune: papel de los anticuerpos frente al déficit de hormona tiroidea. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022. [DOI: 10.1016/j.otorri.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Maikap D, Pradhan A, Padhan P. A Rare Case of Atypical Cogan's Syndrome Presenting as Encephalitis. Mod Rheumatol Case Rep 2021; 6:305-308. [PMID: 34957524 DOI: 10.1093/mrcr/rxab055] [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: 11/11/2021] [Revised: 11/25/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022]
Abstract
Cogan's syndrome (CS) is a rare autoimmune vasculitis of unknown aetiology characterised by non-syphilitic interstitial keratitis, audio-vestibular symptoms, sometimes systemic symptoms and multi-organ involvement. Atypical CS has other ocular features such as scleritis, episcelritis, retinitis and optic neuritis. Diagnosis of CS is purely clinical without a confirmatory test. Hereby, we report a case of atypical CS presenting with features of encephalitis who was treated successfully with intravenous pulse methylprednisolone with cyclophosphamide. It is important to consider Cogan's syndrome in the differential diagnosis of encephalitis with ocular and vestibular symptoms in young patients, as high morbidity and mortality rates are effectively lowered by early immunosuppressive treatment.
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Affiliation(s)
- Debashis Maikap
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Amrita Pradhan
- Department of Ophthalmology, S.C.B Medical college, Cuttack, Odisha, India
| | - Prasanta Padhan
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
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13
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Bason C, Barbieri A, Martinelli N, Olivieri B, Argentino G, Bartoloni E, Beri R, Jadav G, Puccetti A, Tinazzi E, Lunardi C. Identification of a Novel Serological Marker in Seronegative Rheumatoid Arthritis Using the Peptide Library Approach. Front Immunol 2021; 12:753400. [PMID: 34675934 PMCID: PMC8525329 DOI: 10.3389/fimmu.2021.753400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/17/2021] [Indexed: 11/16/2022] Open
Abstract
Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic inflammation mainly affecting the joints leading to cartilage and bone destruction. The definition of seropositive or seronegative RA is based on the presence or absence of rheumatoid factor (RF) and anti-citrullinated peptide antibodies (ACPAs). Other autoantibodies have been identified in the last decade such as antibodies directed against carbamylated antigens, peptidyl-arginine deiminase type 4 and v-Raf murine sarcoma viral oncogene homologue B. In order to identify relevant autoantigens, we screened a random peptide library (RPL) with pooled IgGs obtained from 50 patients with seronegative RA. Patients’ sera were then used in an ELISA test to identify the most frequently recognized peptide among those obtained by screening the RPL. Sera from age- and sex-matched healthy subjects were used as controls. We identified a specific peptide (RA-peptide) recognized by RA patients’ sera, but not by healthy subjects or by patients with other immune-mediated diseases. The majority of sera from seronegative and seropositive RA patients (73.8% and 63.6% respectively) contained IgG antibodies directed against the RA-peptide. Interestingly, this peptide shares homology with some self-antigens, such as Protein-tyrosine kinase 2 beta, B cell scaffold protein, Liprin-alfa1 and Cytotoxic T lymphocyte protein 4. Affinity purified anti-RA-peptide antibodies were able to cross react with these autoantigens. In conclusion, we identified a peptide that is recognized by seropositive and, most importantly, by seronegative RA patients’ sera, but not by healthy subjects, conferring to this epitope a high degree of specificity. This peptide shares also homology with other autoantigens which can be recognized by autoantibodies present in seronegative RA sera. These newly identified autoantibodies, although present also in a percentage of seropositive RA patients, may be considered as novel serum biomarkers for seronegative RA, which lacks the presence of RF and/or ACPAs.
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Affiliation(s)
- Caterina Bason
- Department of Medicine, University of Verona, Verona, Italy
| | - Alessandro Barbieri
- Department of Laboratory Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | | | | | | | - Elena Bartoloni
- Division of Rheumatology, Department of Medicine, University of Perugia, Perugia, Italy
| | - Ruggero Beri
- Department of Medicine, University of Verona, Verona, Italy
| | | | - Antonio Puccetti
- Department of Experimental Medicine, Section of Histology, University of Genova, Genova, Italy
| | - Elisa Tinazzi
- Department of Medicine, University of Verona, Verona, Italy
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14
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Ng B, Crowson MG, Lin V. Management of sudden sensorineural hearing loss among primary care physicians in Canada: a survey study. J Otolaryngol Head Neck Surg 2021; 50:22. [PMID: 33795010 PMCID: PMC8015047 DOI: 10.1186/s40463-021-00498-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/17/2021] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Sudden Sensorineural Hearing Loss (SSNHL) is a medical emergency requiring immediate attention as delayed treatment can lead to permanent and devastating consequences. Primary care physicians are likely the first to be presented with SSNHL and therefore have the crucial role of recognizing it and initiating timely and appropriate management. The aim of this study was to gain insight into the current knowledge and practice trends pertaining to the diagnosis and management of SSNHL among family physicians in Canada. METHODS An 18-question survey targeting Canadian family physicians was marketed through two, physician-only discussion groups on the social media platform Facebook. Responses were collected between August 1st and December 22nd 2019 then aggregated and quantified. RESULTS 52 family physicians submitted responses. 94.2% (n = 49) reported that in their practice, unilateral SSNHL warrants urgent referral to otolaryngology and 84.6% (n = 44) reported that unilateral sudden-onset hearing loss warrants urgent referral for audiological testing. 73.1% of participants (n = 38) reported that they would attempt to differentiate between conductive and sensorineural hearing loss if presented with unilateral, acute or sudden-onset hearing loss. 61.5% (n = 32) would rely on tuning fork tests to inform management decisions, as compared to 94.2% (n = 49) relying on case history and 88.5% (n = 46) on otoscopy. 76.9% (n = 40) would prescribe corticosteroids if presented with confirmed, unilateral SSNHL. CONCLUSION The majority of family physicians in the study would make appropriate referral and treatment decisions in the management of SSNHL, understanding it is a medical emergency. Tuning fork tests are under-utilized for informing management decisions compared to other means of differentiating conductive and sensorineural hearing loss. Further research is needed to understand why some family physicians do not prescribe corticosteroids for treatment of SSNHL, which may then identify any gaps in knowledge or inform improvements in clinical protocol.
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Affiliation(s)
- Benjamin Ng
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada.
| | - Matthew G Crowson
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye & Ear, Boston, MA, USA.,Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, MA, USA
| | - Vincent Lin
- Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
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15
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Buda P, Chyb M, Smorczewska-Kiljan A, Wieteska-Klimczak A, Paczesna A, Kowalczyk-Domagała M, Okarska-Napierała M, Sobalska-Kwapis M, Grochowalski Ł, Słomka M, Sitek A, Ksia Żyk J, Strapagiel D. Association Between rs12037447, rs146732504, rs151078858, rs55723436, and rs6094136 Polymorphisms and Kawasaki Disease in the Population of Polish Children. Front Pediatr 2021; 9:624798. [PMID: 33692975 PMCID: PMC7937642 DOI: 10.3389/fped.2021.624798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Kawasaki disease (KD) is an acute self-limited febrile vasculitis that mainly affects young children. Coronary artery involvement is the most serious complication in children with KD. It is currently the leading cause of acquired cardiac disease in children from developed countries. Literature data indicate a significant role of genetic susceptibility to KD. Objective: The aim of this study was to perform the first Genome-Wide Association Study (GWAS) in a population of Polish children with KD and identify susceptible genes involved in the pathogenesis of KD. Materials and Methods: The blood samples of Kawasaki disease patients (n = 119) were collected between 2016 and 2020, isolated and stored at the Department of Pediatrics, Nutrition and Metabolic Diseases, Children's Memorial Health Institute in Warsaw. The control group was based on Polish donors (n = 6,071) registered as the POPULOUS collection at the Biobank Lab of The Department of Molecular Biophysics in University of Lodz. DNA samples were genotyped for 558,231 Single Nucleotide Polymorphisms (SNPs) using the 24 × 1 Infinium HTS Human Core Exome microarrays according to the protocol provided by the manufacturer. In order to discover and verify genetic risk-factors for KD, association analysis was carried out using PLINK 1.9. Results: Of all 164,395 variants, 5 were shown to occur statistically (padjusted < 0.05) more frequent in Kawasaki disease patients than in controls. Those are: rs12037447 in non-coding sequence (padjusted = 8.329 × 10-4, OR = 8.697, 95% CI; 3.629-20.84) and rs146732504 in KIF25 (padjusted = 0.007354, OR = 11.42, 95% CI; 3.79-34.43), rs151078858 in PTPRJ (padjusted = 0.04513, OR = 8.116, 95% CI; 3.134-21.01), rs55723436 in SPECC1L (padjusted = 0.04596, OR = 5.596, 95% CI; 2.669-11.74), rs6094136 in RPN2 (padjusted = 0.04755, OR = 10.08, 95% CI; 3.385-30.01) genes. Conclusion: Polymorphisms of genes KIF25, PTRPJ, SPECC1L, RNP2 may be linked with the incidence of Kawasaki disease in Polish children.
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Affiliation(s)
- Piotr Buda
- Department of Pediatrics, Nutrition, and Metabolic Diseases, Children's Memorial Health Institute, Warsaw, Poland
| | - Maciej Chyb
- Biobank Lab, Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, Łódź, Poland
| | - Anna Smorczewska-Kiljan
- Department of Pediatrics, Nutrition, and Metabolic Diseases, Children's Memorial Health Institute, Warsaw, Poland
| | - Anna Wieteska-Klimczak
- Department of Pediatrics, Nutrition, and Metabolic Diseases, Children's Memorial Health Institute, Warsaw, Poland
| | - Agata Paczesna
- Department of Cardiology, The Children's Memorial Health Institute, Warsaw, Poland
| | | | | | - Marta Sobalska-Kwapis
- Biobank Lab, Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, Łódź, Poland.,BBMRI.pl Consortium, Wrocław, Poland
| | - Łukasz Grochowalski
- Biobank Lab, Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, Łódź, Poland
| | - Marcin Słomka
- Biobank Lab, Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, Łódź, Poland.,BBMRI.pl Consortium, Wrocław, Poland
| | - Aneta Sitek
- Department of Anthropology, Faculty of Biology and Environmental Protection, University of Lodz, Łódź, Poland
| | - Janusz Ksia Żyk
- Department of Pediatrics, Nutrition, and Metabolic Diseases, Children's Memorial Health Institute, Warsaw, Poland
| | - Dominik Strapagiel
- Biobank Lab, Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, Łódź, Poland.,BBMRI.pl Consortium, Wrocław, Poland
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16
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Ozawa T, Ouhara K, Tsuda R, Munenaga S, Kurihara H, Kohno H, Hamana H, Kobayashi E, Taki H, Tobe K, Sugiyama E, Muraguchi A, Kishi H. Physiologic Target, Molecular Evolution, and Pathogenic Functions of a Monoclonal Anti-Citrullinated Protein Antibody Obtained From a Patient With Rheumatoid Arthritis. Arthritis Rheumatol 2020; 72:2040-2049. [PMID: 32621659 DOI: 10.1002/art.41426] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 06/25/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In plasma from a patient with rheumatoid arthritis (RA), we previously isolated a human monoclonal anti-citrullinated protein antibody (ACPA), CCP-Ab1, that recognizes various citrullinated antigens. In this study, we aimed to explore the physiologic target of CCP-Ab1 and the role of molecular evolution, through affinity maturation, of this ACPA in the onset and the exacerbation of RA. METHODS The target protein of CCP-Ab1 was identified in the plasma of a patient with RA and purified under native conditions. Germline-reverted (GL-rev) CCP-Ab1 was generated, and its reactivity was compared to that of mature CCP-Ab1. The functions of CCP-Ab1 and GL-rev CCP-Ab1 in the onset or exacerbation of autoimmune arthritis were analyzed using autoimmune arthritis-prone SKG mice. RESULTS CCP-Ab1 bound citrullinated fibrinogen under native conditions. In cultures with GL-rev CCP-Ab1, the binding affinity to citrullinated fibrinogen was drastically reduced (P < 0.05). The elements implicated in GL-rev CCP-Ab1 binding to a citrullinated peptide, cfc1-cyc, were almost identical to those implicated in CCP-Ab1 binding. In arthritis-prone SKG mice, CCP-Ab1, but not GL-rev CCP-Ab1, induced significant exacerbation of experimental arthritis (P < 0.05). Increased production of interleukin-6, both in the joint tissue and in the serum, was observed in SKG mice treated with CCP-Ab1 compared to those treated with GL-rev CCP-Ab1 (P < 0.05). Furthermore, the immune complex formed by CCP-Ab1 and fibrinogen was detected at higher concentrations in the synovial tissue of SKG mice administered CCP-Ab1 (P < 0.05 versus control treatment groups). CONCLUSION These data show that germline-encoded CCP-Ab1, which binds weakly to citrullinated fibrinogen, undergoes hypermutation through the activation of naive B cells by citrullinated peptides/proteins, thereby stimulating high reactivity to citrullinated fibrinogen. These findings deepen our understanding of the role of molecular evolution of ACPAs in the onset and exacerbation of RA.
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Affiliation(s)
- Tatsuhiko Ozawa
- University of Toyama, Faculty of Medicine, Academic Assembly, Toyama, Japan
| | - Kazuhisa Ouhara
- Hiroshima University, Graduate School of Biomedical & Sciences, Hiroshima, Japan
| | - Reina Tsuda
- University of Toyama, Faculty of Medicine, Academic Assembly, Toyama, Japan
| | - Syuichi Munenaga
- Hiroshima University, Graduate School of Biomedical & Sciences, Hiroshima, Japan
| | - Hidemi Kurihara
- Hiroshima University, Graduate School of Biomedical & Sciences, Hiroshima, Japan
| | | | - Hiroshi Hamana
- University of Toyama, Faculty of Medicine, Academic Assembly, Toyama, Japan
| | - Eiji Kobayashi
- University of Toyama, Faculty of Medicine, Academic Assembly, Toyama, Japan
| | - Hirofumi Taki
- University of Toyama, Faculty of Medicine, Academic Assembly, Toyama, Japan
| | - Kazuyuki Tobe
- University of Toyama, Faculty of Medicine, Academic Assembly, Toyama, Japan
| | | | - Atsushi Muraguchi
- University of Toyama, Faculty of Medicine, Academic Assembly, Toyama, Japan
| | - Hiroyuki Kishi
- University of Toyama, Faculty of Medicine, Academic Assembly, Toyama, Japan
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17
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Morinaka S, Takano Y, Tsuboi H, Goto D, Sumida T. Familial HLA-B*52 Vasculitis: Maternal, Atypical Cogan's Syndrome with Takayasu Arteritis-mimicking Aortitis and Filial Takayasu Arteritis. Intern Med 2020; 59:1899-1904. [PMID: 32321889 PMCID: PMC7474986 DOI: 10.2169/internalmedicine.4067-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Cogan's syndrome (CS), a rare vasculitis characterized by non-syphilitic, interstitial keratitis and Ménière-like attacks, is classified into "typical" and "atypical" forms, while Takayasu arteritis (TAK) is a rare large-vessel vasculitis associated with human leukocyte antigen (HLA)-B*52. Very few cases meet both the CS and TAK classification criteria. We herein report a 53-year-old woman diagnosed with atypical CS and aortitis similar to TAK. Her 25-year-old daughter manifested TAK without symptoms of CS, and both are HLA-B*52 positive. Our case highlights the difficulties of distinguishing aortitis with atypical CS from aortitis with TAK.
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Affiliation(s)
- Satoshi Morinaka
- Division of Rheumatology, Ibaraki Prefectural Central Hospital, Japan
| | - Yohei Takano
- Division of Rheumatology, Ibaraki Prefectural Central Hospital, Japan
| | - Hiroto Tsuboi
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
| | - Daisuke Goto
- Division of Rheumatology, Ibaraki Prefectural Central Hospital, Japan
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
- Division of Rheumatology, Ibaraki Clinical Education and Training Center, Tsukuba University Hospital, Japan
| | - Takayuki Sumida
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan
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18
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Cogan syndrome: Descriptive analysis and clinical experience of 7 cases diagnosed and treated in two third level hospitals. ACTA ACUST UNITED AC 2020; 17:318-321. [PMID: 32571733 DOI: 10.1016/j.reuma.2019.11.008] [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: 08/01/2019] [Accepted: 11/22/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Cogan's syndrome (CS) is an inflammatory disease classified as variable vessel vasculitis. It is a rare disease with few published series, and therefore we reviewed our experience in the last ten years in two centres. MATERIALS AND METHODS Description of 7 diagnosed cases of CS, according to the classification criteria (typical or atypical), their clinical manifestations, treatments used and their complications. A comparative analysis was performed with the series and cases described in the literature. RESULTS Seven cases were included, three men and four women, with a mean age at diagnosis of 43 years, and an average disease duration of 47 months. Five patients met the typical characteristics according to the 1980 classical criteria, the rest being atypical cases, one due to the absence of interstitial keratitis and another due to a period between the onset of ocular and auditory-vestibular clinical symptoms greater than two years. All received immunosuppressants, methotrexate being the most commonly used, followed by azathioprine. In 5 cases, biological drugs were used, infliximab in 4 times and 2 tocilizumab. One patient died from bacterial endocarditis and septic shock. CONCLUSION The characteristics of the series presented are like those published to date, with clinical differences mainly in the involvement of large vessels. Given the low frequency, it seems necessary to create multicentre records to improve the evidence regarding the management of patients with CS.
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19
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Ralli M, Campo F, Angeletti D, Minni A, Artico M, Greco A, Polimeni A, de Vincentiis M. Pathophysiology and therapy of systemic vasculitides. EXCLI JOURNAL 2020; 19:817-854. [PMID: 32665772 PMCID: PMC7355154 DOI: 10.17179/excli2020-1512] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 12/14/2022]
Abstract
Systemic vasculitides represent uncommon conditions characterized by the inflammation of blood vessels that can lead to different complex disorders limited to one organ or potentially involving multiple organs and systems. Systemic vasculitides are classified according to the diameter of the vessel that they mainly affect (small, medium, large, or variable). The pathogenetic mechanisms of systemic vasculitides are still partly unknown, as well as their genetic basis. For most of the primary systemic vasculitides, a single gold standard test is not available, and diagnosis is often made after having ruled out other mimicking conditions. Current research has focused on new management protocol and therapeutic strategies aimed at improving long-term patient outcomes and avoiding progression to multiorgan failure with irreversible damage. In this narrative review, authors describe different forms of systemic vasculitides through a review of the literature, with the aim of highlighting the current knowledge and recent findings on etiopathogenesis, diagnosis and therapy.
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Affiliation(s)
- Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Flaminia Campo
- Department of Sense Organs, Sapienza University of Rome, Italy
| | | | - Antonio Minni
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Marco Artico
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Italy
| | - Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Italy
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20
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Espinoza GM, Wheeler J, Temprano KK, Keller AP. Cogan's Syndrome: Clinical Presentations and Update on Treatment. Curr Allergy Asthma Rep 2020; 20:46. [PMID: 32548646 DOI: 10.1007/s11882-020-00945-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Cogan's syndrome (CS) is a rare systemic vasculitis that can severely affect vision and hearing, which may also have significant systemic effects. Early recognition of this autoimmune disorder and intervention can minimize disabling and irreversible damage. RECENT FINDINGS This article will review the varying clinical presentations of CS and emerging information of systemic disease associated with CS. We will also review recently published promising treatment outcomes using immune modulating medications. As our framework for recognizing the markers of CS and the associated systemic disorders expands, more effective guidelines and treatment options may emerge.
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Affiliation(s)
- Gabriela Mabel Espinoza
- Department of Ophthalmology, Saint Louis University Eye Institute, Saint Louis University School of Medicine, 1755 South Grand Blvd., St. Louis, MO, 63104, USA.
| | - Joseph Wheeler
- Department of Internal Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd. Doisy Hall 210, St. Louis, MO, 63104, USA
| | - Katherine K Temprano
- Rheumatology & Internal Medicine Associates, BJC Medical Group, 3023 N. Ballas Road, Suite 500D, St. Louis, MO, 63131, USA
| | - Angela Prost Keller
- Department of Ophthalmology, Saint Louis University Eye Institute, Saint Louis University School of Medicine, 1755 South Grand Blvd., St. Louis, MO, 63104, USA
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21
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Scherg F, Haag F, Krieger T. Off-label application of intravenous immunoglobulin (IVIG) for treatment of Cogan's syndrome during pregnancy. BMJ Case Rep 2019; 12:e227917. [PMID: 31604714 PMCID: PMC6803144 DOI: 10.1136/bcr-2018-227917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 11/03/2022] Open
Abstract
We report the case of a woman with Cogan's syndrome concomitant with the wish to have children. After three major flares of the disease that led to unilateral deafness, immunosuppressive therapy with prednisolone and azathioprine was started. Because of the severe side effects, an off-label therapy with intravenous immunoglobulin (IVIG) was initiated, under which our patient has since given birth to three healthy children. To our knowledge this is the first report to describe Cogan's syndrome with multiple successful pregnancies under IVIG treatment.
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Affiliation(s)
- Felix Scherg
- Institute of Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Friedrich Haag
- Institute of Immunology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Krieger
- Institute of Clinical Chemistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Primary Immunodeficiencies, MVZ Rheumatologie und Autoimmunmedizin GmbH, Hamburg, Germany
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22
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Russo FY, Ralli M, De Seta D, Mancini P, Lambiase A, Artico M, de Vincentiis M, Greco A. Autoimmune vertigo: an update on vestibular disorders associated with autoimmune mechanisms. Immunol Res 2019; 66:675-685. [PMID: 30270399 DOI: 10.1007/s12026-018-9023-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The role of the immune system in mediating cochleovestibular pathologies has received increasing attention in recent years. Autoimmune vertigo may be an invalidating condition and may worsen the quality of life of affected patients, especially in the cases of delayed diagnosis. Since the etiopathogenesis is still not clear, also the treatment is not yet completely delineated. According to the clinical presentation, autoimmune vertigo can present as an isolated disorder or in association with systemic autoimmune diseases. The main feature in autoimmune vertigo is the presence of an abnormal immune response, in either absence or presence of systemic autoimmune disease, directed against delicate components of the inner ear. This may determine a functional or anatomical alteration, with an inflammatory reaction often devastating for hearing and balance. Being the exact pathogenesis unknown, the diagnosis of autoimmune vertigo is based either on clinical criteria or on a positive response to steroids. The earlier the diagnosis is made, the sooner the therapy can be installed, giving a chance to the recovery of inner ear damages. Corticosteroids represent the most effective and universally accepted treatment, even if other immunomodulatory drugs are now having a more extensive use. HIGHLIGHTS: Vertigo is relatively frequent in autoimmune diseases; however, it is often misdiagnosed or attributed to central nervous system alterations rather to specific inner ear involvement. Vertigo and other audiovestibular symptoms may be the first manifestation of an autoimmune disease and if correctly addressed could significantly contribute to early diagnosis of the underlying autoimmune disease. Early diagnosis of immune-related vertigo can lead to prompt initiation of targeted therapy with elevate chances of preventing irreversible damages to the inner ear. The presence of alternating phases of well-being and disabling symptoms in patients with vertigo should always been considered, as they could suggest an underlying autoimmune condition.
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Affiliation(s)
- Francesca Yoshie Russo
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100, Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100, Rome, Italy
| | - Daniele De Seta
- Department of Oral and Maxillo-facial Surgery, Sapienza University of Rome, Viale del Policlinico 155, 00100, Rome, Italy.
| | - Patrizia Mancini
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100, Rome, Italy
| | - Alessandro Lambiase
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100, Rome, Italy
| | - Marco Artico
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100, Rome, Italy
| | - Marco de Vincentiis
- Department of Oral and Maxillo-facial Surgery, Sapienza University of Rome, Viale del Policlinico 155, 00100, Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100, Rome, Italy
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23
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Triplett JD, Buzzard KA, Lubomski M, Riminton DS, Barnett MH, Welgampola MS, Halmagyi GM, Nguyen M, Landau K, Lee AG, Plant GT, Fraser CL, Reddel SW, Hardy TA. Immune-mediated conditions affecting the brain, eye and ear (BEE syndromes). J Neurol Neurosurg Psychiatry 2019; 90:882-894. [PMID: 30852493 DOI: 10.1136/jnnp-2018-319002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 12/19/2022]
Abstract
The triad of central nervous system symptoms, visual disturbance and hearing impairment is an oft-encountered clinical scenario. A number of immune-mediated diseases should be considered among the differential diagnoses including: Susac syndrome, Cogan syndrome or Vogt-Koyanagi-Harada disease; demyelinating conditions such as multiple sclerosis or neuromyelitis optica spectrum disorder; systemic diseases such as systemic lupus erythematosus, Sjögren syndrome or Behcet disease and granulomatous diseases such as sarcoidosis. In this article, we coin the term 'BEE syndromes' to draw attention to the various immune-mediated diseases that affect the brain, eye and ear. We present common disease manifestations and identify key clinical and investigation features.
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Affiliation(s)
- James D Triplett
- Neuroimmunology Clinic, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Katherine A Buzzard
- Department of Neurosciences, Eastern Health, Monash University, Clayton, Victoria, Australia
| | - Michal Lubomski
- Neuroimmunology Clinic, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - D Sean Riminton
- Neuroimmunology Clinic, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Michael H Barnett
- Department of Neurology, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Miriam S Welgampola
- Department of Neurology, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - G Michael Halmagyi
- Department of Neurology, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - MaiAnh Nguyen
- Neuroimmunology Clinic, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Klara Landau
- Department of Ophthalmology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital in Houston, Houston, Texas, USA.,Weill Cornell Medical College, Cornell University, New York City, New York, USA.,University of Texas Medical Branch (UTMB), Baylor College of Medicine, The UT MD Anderson Cancer Center, Texas A and M College of Medicine (AGL), Houston, Texas, USA
| | - Gordon T Plant
- National Hospital for Neurology and Neurosurgery and Moorfield's Eye Hospital, University College London, London, UK
| | - Clare L Fraser
- Brain and Mind Centre, University of Sydney, Syndey, New South Wales, Australia
| | - Stephen W Reddel
- Neuroimmunology Clinic, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Todd A Hardy
- Neuroimmunology Clinic, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
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24
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Lee SU, Kim JS, Hyon JY, Ha YJ, Kim HJ, Song JJ, Choi JY, Yang X. Pearls & Oy-sters: Cogan syndrome. Neurology 2019; 93:39-41. [DOI: 10.1212/wnl.0000000000007733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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25
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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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Abstract
The vasculitides are diseases characterized by inflammation of blood vessels and inflammatory leukocytes in vessel walls. There is an increased propensity for ischemic stroke, resulting from compromise of vessel lumina with distal tissue ischemia; and hemorrhagic or nonhemorrhagic stroke, and aneurysmal formation and bleeding, due to loss of vessel integrity.
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Affiliation(s)
- David S Younger
- Department of Neurology, Division of Neuro-Epidemiology, New York University School of Medicine, New York, NY, USA; School of Public Health, City University of New York, New York, NY, USA.
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27
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Sakano H, Harris JP. Emerging options in immune-mediated hearing loss. Laryngoscope Investig Otolaryngol 2018; 4:102-108. [PMID: 30828626 PMCID: PMC6383306 DOI: 10.1002/lio2.205] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/27/2018] [Accepted: 07/12/2018] [Indexed: 12/14/2022] Open
Abstract
Objective AIED (autoimmune inner ear disease) is an autoimmune process that leads to the dysfunction of the inner ear, resulting in fluctuating, audiovestibular symptoms. Although the pathogenesis is likely heterogeneous, immune processes within the inner ear ultimately lead to histopathologic changes and sensorineural hearing loss. This review will discuss the latest evidence on treatment options. Methods A literature search on articles pertaining to the treatment of autoimmune inner ear disease was performed on PubMed. Results Corticosteroid treatment continues to remain as first line therapy for AIED but long-term responsiveness is poor. Cytotoxic chemotherapies can be effective alternatives for steroid nonresponsive patients, but significant side effects may limit their use. Intratympanic steroid injections are beneficial and although there is not enough evidence currently to supplant oral steroid trial they may be a useful adjunct if steroid toxicity is an issue. The efficacy of biologic agents has been variable. Compared to placebo, etanercept does not improve the hearing improvement already attained by steroids alone. However, open pilot studies of other biologic agents show hearing improvements, improvements in tinnitus/aural fullness/vertigo, ability to wean steroid dependency, or benefits in steroid-resistant AIED. Conclusion There is currently not enough evidence that alternative treatments supersede the use of initial steroid treatment. Biologic agents and intratympanic steroid injections are relatively well tolerated and should be considered as adjunctive therapy. More studies on the efficacy of various biologics and more studies on the treatment of steroid resistant disease especially after initial benefit are still needed. For those who eventually lose their hearing, cochlear implantation remains as a viable option. Level of Evidence expert opinion.
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Affiliation(s)
- Hitomi Sakano
- Department of Otolaryngology-Head and Neck Surgery University of California, San Diego San Diego California U.S.A
| | - Jeffrey P Harris
- Department of Otolaryngology-Head and Neck Surgery University of California, San Diego San Diego California U.S.A
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28
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Girasoli L, Cazzador D, Padoan R, Nardello E, Felicetti M, Zanoletti E, Schiavon F, Bovo R. Update on Vertigo in Autoimmune Disorders, from Diagnosis to Treatment. J Immunol Res 2018; 2018:5072582. [PMID: 30356417 PMCID: PMC6178164 DOI: 10.1155/2018/5072582] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 09/03/2018] [Indexed: 12/18/2022] Open
Abstract
The prevalence of autoimmune diseases has been increasing over the last 20 years. The clinical presentation of this large and heterogeneous group of disorders depends on whether the involvement is organ-specific or non-organ-specific. Dizziness, vertigo, and disequilibrium are common symptoms reported by patients with vestibulocochlear involvement. The association of vertigo and autoimmune diseases has been largely documented, suggesting that autoimmune disorders could be overrepresented in patients with vertigo in comparison to the general population. The aim of this review is to present the recent literature findings in the field of autoimmune-mediated diseases with cochleovestibular involvement, focusing on the clinical presentation, diagnosis, and treatment of immune-mediated inner ear diseases including autoimmune inner ear disease (AIED), Meniere's disease, and bilateral vestibulopathy, as well as of systemic autoimmune diseases with audiovestibular disorders, namely, Behçet's disease, Cogan's syndrome, sarcoidosis, autoimmune thyroid disease, Vogt-Koyanagi-Harada syndrome, relapsing polychondritis, systemic lupus erythematosus, antiphospholipid syndrome, IgG4-related disease, and ANCA-associated vasculitides.
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Affiliation(s)
- Laura Girasoli
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Diego Cazzador
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Roberto Padoan
- Department of Medicine DIMED, Operative Unit of Rheumatology, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Ennio Nardello
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Mara Felicetti
- Department of Medicine DIMED, Operative Unit of Rheumatology, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Elisabetta Zanoletti
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Franco Schiavon
- Department of Medicine DIMED, Operative Unit of Rheumatology, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
| | - Roberto Bovo
- Department of Neurosciences, Otorhinolaryngology Unit, University of Padua, Via Giustiniani, 2, 35128 Padova, Italy
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29
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Audiovestibular Symptoms in Systemic Autoimmune Diseases. J Immunol Res 2018; 2018:5798103. [PMID: 30211232 PMCID: PMC6120292 DOI: 10.1155/2018/5798103] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 06/11/2018] [Accepted: 07/04/2018] [Indexed: 12/16/2022] Open
Abstract
Immune-mediated inner ear disease can be primary, when the autoimmune response is against the inner ear, or secondary. The latter is characterized by the involvement of the ear in the presence of systemic autoimmune conditions. Sensorineural hearing loss is the most common audiovestibular symptom associated with systemic autoimmune diseases, although conductive hearing impairment may also be present. Hearing loss may present in a sudden, slowly, rapidly progressive or fluctuating form, and is mostly bilateral and asymmetric. Hearing loss shows a good response to corticosteroid therapy that may lead to near-complete hearing restoration. Vestibular symptoms, tinnitus, and aural fullness can be found in patients with systemic autoimmune diseases; they often mimic primary inner ear disorders such as Menière's disease and mainly affect both ears simultaneously. Awareness of inner ear involvement in systemic autoimmune diseases is essential for the good response shown to appropriate treatment. However, it is often misdiagnosed due to variable clinical presentation, limited knowledge, sparse evidence, and lack of specific diagnostic tests. The aim of this review is to analyse available evidence, often only reported in the form of case reports due to the rarity of some of these conditions, of the different clinical presentations of audiological and vestibular symptoms in systemic autoimmune diseases.
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30
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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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31
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Li YH, Gao YP, Dong J, Shi LJ, Sun XL, Li R, Zhang XW, Liu Y, Long L, He J, Zhong QJ, Morand E, Yang G, Li ZG. Identification of a novel autoantibody against self-vimentin specific in secondary Sjögren's syndrome. Arthritis Res Ther 2018; 20:30. [PMID: 29433534 PMCID: PMC5810024 DOI: 10.1186/s13075-017-1508-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 12/28/2017] [Indexed: 12/24/2022] Open
Abstract
Background Sjögren’s syndrome (SS) is a primary autoimmune disease (pSS) or secondarily associated with other autoimmune diseases (sSS). The mechanisms underlying immune dysregulation in this syndrome remain unknown, and clinically it is difficult to diagnose owing to a lack of specific biomarkers. Methods We extracted immunoglobulins (Igs) from the sera of patients with sSS associated with rheumatoid arthritis (RA) and used them to screen a phage display library of peptides with random sequences. Results Our results show that an sSS-specific peptide, designated 3S-P, was recognized by sera of 68.2% (60 of 88) patients with sSS, 66.2% of patients with RA-sSS, and 76.5% of patients with systemic lupus erythematosus (SLE)-sSS. The anti-3S-P antibody was scarcely found in patients with pSS (1.8%), RA (1.3%), SLE (4.2%), ankylosing spondylitis (0%), and gout (3.3%), as well as in healthy donors (2%). The 3S-P-binding Igs (antibodies) were used to identify antigens from salivary glands and synovial tissues from patients with sSS. A putative target autoantigen expressed in the synovium and salivary gland recognized by anti-3S-P antibody was identified as self-vimentin. Conclusions This novel autoantibody is highly specific in the diagnosis of sSS, and the underlying molecular mechanism of the disease might be epitope spreading involved with vimentin. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1508-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yu-Hui Li
- Department of Rheumatology & Immunology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China
| | - Ya-Ping Gao
- Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Jie Dong
- Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Lian-Jie Shi
- Department of Rheumatology & Immunology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China
| | - Xiao-Lin Sun
- Department of Rheumatology & Immunology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China
| | - Ru Li
- Department of Rheumatology & Immunology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China
| | - Xue-Wu Zhang
- Department of Rheumatology & Immunology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China
| | - Yu Liu
- Department of Rheumatology & Immunology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China
| | - Li Long
- Department of Rheumatology & Immunology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China
| | - Jing He
- Department of Rheumatology & Immunology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China
| | - Qun-Jie Zhong
- Arthritis Clinic and Research Center, Peking University People's Hospital, Beijing, China
| | - Eric Morand
- Center for Inflammatory Diseases, Southern Clinical School, Monash University, Melbourne, Australia.
| | - Guang Yang
- Beijing Institute of Basic Medical Sciences, Beijing, China.
| | - Zhan-Guo Li
- Department of Rheumatology & Immunology, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, 100044, China.
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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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33
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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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34
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Almeida RS, Oliveira AA, Pego PM, Abuowda Y, Gaspar I, Costa JM. Sensorineural hearing loss as the first manifestation of Sjögren's syndrome. Rev Assoc Med Bras (1992) 2017; 63:7-9. [PMID: 28225872 DOI: 10.1590/1806-9282.63.01.7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 05/31/2016] [Indexed: 11/22/2022] Open
Affiliation(s)
- Raquel Sousa Almeida
- Autoimmune Diseases Clinic, 3rd Department of Internal Medicine, Hospital Distrital de Santarém, Portugal
| | - Ana Alves Oliveira
- Autoimmune Diseases Clinic, 3rd Department of Internal Medicine, Hospital Distrital de Santarém, Portugal
| | - Petra M Pego
- Autoimmune Diseases Clinic, 3rd Department of Internal Medicine, Hospital Distrital de Santarém, Portugal
| | - Yahia Abuowda
- Autoimmune Diseases Clinic, 3rd Department of Internal Medicine, Hospital Distrital de Santarém, Portugal
| | - Iuri Gaspar
- Otorhinolaryngology Department, Hospital Distrital de Santarém, Portugal
| | - João Matos Costa
- Autoimmune Diseases Clinic, 3rd Department of Internal Medicine, Hospital Distrital de Santarém, Portugal
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35
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Lee JM, Kim JY, Bok J, Kim KS, Choi JY, Kim SH. Identification of evidence for autoimmune pathology of bilateral sudden sensorineural hearing loss using proteomic analysis. Clin Immunol 2017. [DOI: 10.1016/j.clim.2017.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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36
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Gunes A, Karakus MF, Telli TA, Gunes NA, Mutlu M. The effect of thyroid autoantibody positivity on the functions of internal ear. Eur Arch Otorhinolaryngol 2017; 274:3853-3858. [PMID: 28821945 DOI: 10.1007/s00405-017-4723-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/16/2017] [Indexed: 11/24/2022]
Abstract
The objective of the study is to investigate if any significant difference exists in hearing thresholds and tympanometric examination results among patients whose thyroid antibody positivity was detected approximately 1 year or at least 5 years ago. Study population aged less than 40 years consisted of 17 patients who had thyroid antibody positivities for an average of 1 year (first group), 15 patients who were followed up for at least 5 years for thyroid antibody positivity (second group), and 18 volunteers (third group). Tympanometric examination results, stapes reflex, SRT, SD, and pure tone values were examined. When the second group and the third group were compared, significant results were obtained at hearing frequencies between 500 and 4000 Hz. When the first group and the third group were compared, only at 1000 Hz threshold significant results were obtained. During evaluation of hearing frequencies between 250 and 8000 Hz, significant results were not observed between the second group and the first group. When the first and the second groups were compared with the control group, significant results were obtained as for tympanometric examination findings and significant results were not observed between the second group and the first group. A significant difference was not detected as for the results of stapes reflex. Since thyroid antibody positivity affects the functions of internal ear, these patients should be more closely monitored. Since these effects become deeper in line with increased exposure to autoantibody positivity, variations in auditory responses should be more attentively monitored.
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Affiliation(s)
- Akif Gunes
- Department of Otorhinolaryngology, Eskisehir State Hospital, Eskisehir, Turkey.
| | - Mehmet Fatih Karakus
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Tugba Akin Telli
- Department of Medical Oncology, Medical School, Marmara University, Istanbul, Turkey
| | | | - Murad Mutlu
- Department of Otorhinolaryngology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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Maiolino L, Cocuzza S, Conti A, Licciardello L, Serra A, Gallina S. Autoimmune Ear Disease: Clinical and Diagnostic Relevance in Cogan's Sydrome. Audiol Res 2017; 7:162. [PMID: 28458810 PMCID: PMC5391519 DOI: 10.4081/audiores.2017.162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 01/02/2017] [Accepted: 01/02/2017] [Indexed: 12/28/2022] Open
Abstract
The autoimmune inner ear disease is a clinical syndrome with uncertain pathogenesis that is often associated to rapidly progressive hearing loss that, especially at the early stages of disease, may be at monoaural localization, although more often it is at binaural localization. It usually occurs as a sudden deafness, or a rapidly progressive sensorineural hearing loss. In this study a particular form of autoimmune inner ear disease is described, Cogan’s syndrome. Cogan’s syndrome is a chronic inflammatory disorder that most commonly affects young adults. Clinical hallmarks are interstitial keratitis, vestibular and auditory dysfunction. Associations between Cogan’s syndrome and systemic vasculitis, as well as aortitis, also exist. We report a case of a young woman who presented audiological and systemic characteristics attributable to Cogan’s syndrome. In the description of the case we illustrate how the appearance and evolution of the disease presented.
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Antibodies Directed against a Peptide Epitope of a Klebsiella pneumoniae-Derived Protein Are Present in Ankylosing Spondylitis. PLoS One 2017; 12:e0171073. [PMID: 28135336 PMCID: PMC5279781 DOI: 10.1371/journal.pone.0171073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 01/15/2017] [Indexed: 12/24/2022] Open
Abstract
Ankylosing spondylitis (AS) is a chronic inflammatory arthritis of unknown origin. Its autoimmune origin has been suggested but never proven. Several reports have implicated Klebsiella pneumoniae as a triggering or perpetuating factor in AS; however, its role in the disease pathogenesis remains debated. Moreover, despite extensive investigations, a biomarker for AS has not yet been identified. To clarify these issues, we screened a random peptide library with pooled IgGs obtained from 40 patients with AS. A peptide (AS peptide) selected from the library was recognized by serum IgGs from 170 of 200 (85%) patients with AS but not by serum specimens from 100 healthy controls. Interestingly, the AS peptide shows a sequence similarity with several molecules expressed at the fibrocartilaginous sites that are primarily involved in the AS inflammatory process. Moreover, the peptide is highly homologous to a Klebsiella pneumoniae dipeptidase (DPP) protein. The antibody affinity purified against the AS peptide recognizes the autoantigens and the DPP protein. Furthermore, serum IgG antibodies against the Klebsiella DPP121-145 peptide epitope were detected in 190 of 200 patients with AS (95%), 3 of 200 patients with rheumatoid arthritis (1.5%) and only 1 of 100 (1%) patients with psoriatic arthritis. Such reactivity was not detected in healthy control donors. Our results show that antibodies directed against an epitope of a Klebsiella pneumoniae-derived protein are present in nearly all patients with AS. In the absence of serological biomarkers for AS, such antibodies may represent a useful tool in the diagnosis of the disease.
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Bason C, Pagnini I, Brucato A, Maestroni S, Puccetti A, Lunardi C, Cimaz R. Congenital heart block and immune mediated sensorineural hearing loss: possible cross reactivity of immune response. Lupus 2016; 26:835-840. [PMID: 27913750 DOI: 10.1177/0961203316682099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Immune-mediated sensorineural hearing loss may complicate systemic autoimmune diseases. We have previously reported the presence of antibodies directed against inner ear antigens in patients with Cogan syndrome, a disease characterized by sudden hearing loss and interstitial keratitis. Such autoantibodies cross-react with an epitope of SSA/Ro60 protein. Anti-Ro/SSA antibodies in pregnant women cross the placenta and reach the fetal tissues inducing an immune-mediated damage of the cardiac conduction system. We wanted to evaluate whether mothers with anti-Ro/SSA antibodies who gave birth to children with congenital heart block have antibodies directed against inner ear antigens and whether these antibodies are connected with the presence of immune-mediated sensorineural hearing loss. We did not find anti-inner ear antibodies in the majority of the mothers. On the contrary a 13-year-old boy with congenital heart block and sensorineural hearing loss was positive for the presence of anti-inner ear antigens antibodies. Moreover his serum was positive for the presence of anti-Ro60 peptide antibodies but did not recognize the entire protein Ro60 (TROVE2), a behaviour similar to that of sera from patients with Cogan syndrome. In conclusion the data obtained so far show that anti-inner ear antibodies do not recognize the entire protein TROVE2 and do not support the hypothesis that such antibodies may be involved in the pathogenesis of congenital heart block.
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Affiliation(s)
- C Bason
- 1 Department of Medicine, University of Verona, Verona, Italy
| | - I Pagnini
- 2 Rheumatology Unit, Anna Meyer Children's Hospital and University of Florence, Florence, Italy
| | - A Brucato
- 3 Internal Medicine, Ospedali Riuniti di Bergamo, Bergamo, Italy
| | - S Maestroni
- 3 Internal Medicine, Ospedali Riuniti di Bergamo, Bergamo, Italy
| | - A Puccetti
- 4 Immunology Area, Ospedale Pediatrico Bambin Gesù, Rome, Italy
| | - C Lunardi
- 1 Department of Medicine, University of Verona, Verona, Italy
| | - R Cimaz
- 2 Rheumatology Unit, Anna Meyer Children's Hospital and University of Florence, Florence, Italy
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Rituximab Not Effective for Hearing Loss in Cogan's Syndrome. Case Rep Rheumatol 2016; 2016:8352893. [PMID: 27843668 PMCID: PMC5098068 DOI: 10.1155/2016/8352893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/07/2016] [Indexed: 11/18/2022] Open
Abstract
Importance. Rituximab was not effective in ameliorating the hearing loss in a patient with atypical Cogan's syndrome. Observations. We report the case of a patient who developed acute bilateral uveitis and sensorineural hearing loss. A diagnosis of atypical Cogan's syndrome was made. The patient's hearing loss did not improve despite high dose steroids and azathioprine. Rituximab was administered given a recent report of its efficacy in a patient with refractory disease; however, our patient's hearing loss did not improve. Conclusion. Hearing loss in Cogan's syndrome is difficult to treat. Though rituximab was ineffective in our case, earlier administration in the disease course could be effective for future patients.
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Ranjbar M, Mohi A, Pföhler C, Grisanti S, Rudolf M. Introducing MARCo: Histoserological Findings of a Multi-Organic Paraneoplastic Syndrome in Cutaneous Melanoma Patients. Dermatol Ther (Heidelb) 2016; 6:659-666. [PMID: 27586435 PMCID: PMC5120631 DOI: 10.1007/s13555-016-0142-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Indexed: 11/29/2022] Open
Abstract
Introduction Cutaneous melanoma (CM) is an aggressive skin cancer entity, causing most skin cancer-related deaths. Autoimmune disorders have been described as potential paraneoplastic complications. The purpose of this study was to elucidate the possibility of a combinatory paraneoplastic affection of the retina and cochlea in patients with CM. Methods Sera samples from CM patients were used for indirect immunofluorescence on histological retinal and cochlear sections. Furthermore, the serum specimen of a patient with symptomatic affection of both organs was analyzed by multiplex ELISA (enzyme-linked immunosorbent assay) for various cytokines including CD163 (cluster of differentiation 163). Results Eleven patients were diagnosed with CM. Autoantibodies against structures of the inner ear were confirmed in all patients who were tested positive for antiretinal antibodies as well. CD163 was significantly elevated in the double-symptomatic patient, who developed metastatic disease. Conclusion Paraneoplastic disease of CM can affect more than one organ and this affect may be correlated with the individual prognosis. Therefore, a thorough anamnesis is needed to avoid missing potential symptoms.
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Affiliation(s)
- Mahdy Ranjbar
- Department of Ophthalmology, University of Lübeck, Lübeck, Germany. .,Laboratory for Angiogenesis and Ocular Cell Transplantation, University of Lübeck, Lübeck, Germany.
| | - Armin Mohi
- Department of Ophthalmology, University of Lübeck, Lübeck, Germany.,Translational Macula Research Laboratory, University of Lübeck, Lübeck, Germany
| | - Claudia Pföhler
- Department of Dermatology, University Hospital of Saarland, Homburg/Saar, Germany
| | | | - Martin Rudolf
- Department of Ophthalmology, University of Lübeck, Lübeck, Germany.,Translational Macula Research Laboratory, University of Lübeck, Lübeck, Germany
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García-Berrocal JR, Ramírez-Camacho R, Trinidad A, Zurita M, de la Fuente R, Lobo D. Controversies and Criticisms on Designs for Experimental Autoimmune Labyrinthitis. Ann Otol Rhinol Laryngol 2016; 113:404-10. [PMID: 15174770 DOI: 10.1177/000348940411300512] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although immune-mediated inner ear disease was reported around 25 years ago, numerous attempts to identify the inner ear antigens have been performed. Experimental animal models have been used to study the immune mechanisms involved in hearing loss and to develop new therapies. Because animal models of autoimmune labyrinthitis have been developed by means of different antigens, we cannot yet show a valid immunopathologic explanation. A critical analysis of the more relevant experimental models employed has been performed in order to validate the methodology. Comparison between these models and animals with spontaneous systemic autoimmune disease has raised more questions concerning the pathophysiology of autoimmune hearing loss. A new pathogenetic theory is suggested, involving the supporting cells of the organ of Corti.
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Affiliation(s)
- José Ramón García-Berrocal
- Service of Otorhinolaryngology, Hospital Universitario Puerta de Hierro, Autónoma University, Madrid, Spain
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Sekiya K, Fukushima M, Teismann H, Lagemann L, Kakigi R, Pantev C, Okamoto H. Neuro-rehabilitation Approach for Sudden Sensorineural Hearing Loss. J Vis Exp 2016:e53264. [PMID: 26863274 PMCID: PMC4781698 DOI: 10.3791/53264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Sudden sensorineural hearing loss (SSHL) is characterized by acute, idiopathic hearing loss. The estimated incidence rate is 5-30 cases per 100,000 people per year. The causes of SSHL and the mechanisms underlying SSHL currently remain unknown. Based on several hypotheses such as a circulatory disturbance to the cochlea, viral infection, and autoimmune disease, pharmaco-therapeutic approaches have been applied to treat SSHL patients; however, the efficacy of the standard treatment, corticosteroid therapy, is still under debate. Exposure to intense sounds has been shown to cause permanent damage to the auditory system; however, exposure to a moderate level enriched acoustic environment after noise trauma may reduce hearing impairments. Several neuroimaging studies recently suggested that the onset of SSHL induced maladaptive cortical reorganization in the human auditory cortex, and that the degree of cortical reorganization in the acute SSHL phase negatively correlated with the recovery rate from hearing loss. This article reports the development of a novel neuro-rehabilitation approach for SSHL, "constraint-induced sound therapy (CIST)". The aim of the CIST protocol is to prevent or reduce maladaptive cortical reorganization by using an enriched acoustic environment. The canal of the intact ear of SSHL patients is plugged in order to motivate them to actively use the affected ear and thereby prevent progress of maladaptive cortical reorganization. The affected ear is also exposed to music via a headphone for 6 hr per day during hospitalization. The CIST protocol appears to be a safe, easy, inexpensive, and effective treatment for SSHL.
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Affiliation(s)
- Kenichi Sekiya
- Department of Integrative Physiology, National Institute for Physiological Sciences; Department of Otolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences and Medical School
| | | | - Henning Teismann
- Institute for Biomagnetism and Biosignalanalysis, University of Muenster; Institute for Epidemiology and Social Medicine, University of Muenster
| | - Lothar Lagemann
- Institute for Biomagnetism and Biosignalanalysis, University of Muenster
| | - Ryusuke Kakigi
- Department of Integrative Physiology, National Institute for Physiological Sciences; Sokendai Graduate University for Advanced Studies
| | - Christo Pantev
- Institute for Biomagnetism and Biosignalanalysis, University of Muenster
| | - Hidehiko Okamoto
- Department of Integrative Physiology, National Institute for Physiological Sciences; Institute for Biomagnetism and Biosignalanalysis, University of Muenster; Sokendai Graduate University for Advanced Studies;
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Renda L, Parlak M, Selçuk ÖT, Renda R, Eyigör H, Yılmaz MD, Osma Ü, Filiz S. Do antithyroid antibodies affect hearing outcomes in patients with pediatric euthyroid Hashimoto's thyroiditis? Int J Pediatr Otorhinolaryngol 2015; 79:2043-9. [PMID: 26388187 DOI: 10.1016/j.ijporl.2015.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 09/03/2015] [Accepted: 09/04/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Hashimoto's thyroiditis (HT) is the most common autoimmune thyroid disease in children. HT is a multifaceted disease with a variable clinicopathological presentation, including hearing impairment. It is known that hearing function is negatively affected in patients with thyroid disorders. The literature includes a very limited number of studies on hearing function in euthyroid pediatric patients with HT. The aim of this study was to determine the relationship between cochlear function and HT, independent of thyroid function. MATERIALS AND METHODS The study included 48 children and adolescents (42 females and 6 males) aged 9-18 years that were diagnosed as HT, and 30 gender- and age-matched healthy controls. Hearing was assessed via otoscopy, tympanometry, pure-tone audiometry, and measurement of distortion product otoacoustic emissions. RESULTS There weren't any significant differences in pure tone thresholds between the 2 groups based on pure-tone audiometry, except in the right ear at 6kHz and 8kHz. Distortion product otoacoustic emissions signal to noise ratios were significantly lower in the HT group than in the control group at 4 different frequencies (6kHz [left ear], 8kHz [left ear], 1.5kHz [right ear], and 6kHz [right ear]) (P<0.05). The signal to noise ratios at all frequencies were <6dB in 3% of left ears and 2.5% of right ears in the control group, versus 12.5% of left ears and 9.6% of right ears in the HT group. Distortion product amplitudes were significantly lower in the HT group than in the control group for both left and right ears at 1kHz, 1.5kHz, 3kHz, and 8kHz, and at 2kHz for left ears only (P<0.05). CONCLUSIONS The present findings show that cochlear function was lower in the HT group than in the control group. Accordingly, we think that hearing in patients with HT should be monitored periodically, even if their hearing thresholds are within normal limits. Thyroid autoimmunity appears to play an important role in a decrease in cochlear activity in pediatric HT patients.
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Affiliation(s)
- Levent Renda
- Department of Otolaryngology - Head and Neck Surgery, Antalya Research and Education Hospital, Antalya, Turkey.
| | - Mesut Parlak
- Department of Pediatric Endocrinology, Antalya Research and Education Hospital, Antalya, Turkey
| | - Ömer Tarık Selçuk
- Department of Otolaryngology - Head and Neck Surgery, Antalya Research and Education Hospital, Antalya, Turkey
| | - Rahime Renda
- Department of Pediatric Nephrology, Antalya Research and Education Hospital, Antalya, Turkey
| | - Hülya Eyigör
- Department of Otolaryngology - Head and Neck Surgery, Antalya Research and Education Hospital, Antalya, Turkey
| | - Mustafa Deniz Yılmaz
- Department of Otolaryngology - Head and Neck Surgery, Antalya Research and Education Hospital, Antalya, Turkey
| | - Üstün Osma
- Department of Otolaryngology - Head and Neck Surgery, Antalya Research and Education Hospital, Antalya, Turkey
| | - Serkan Filiz
- Department of Pediatric Allergy, Antalya Research and Education Hospital, Antalya, Turkey
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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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Jung DH, Nadol JB, Folkerth RD, Merola JF. Histopathology of the Inner Ear in a Case With Recent Onset of Cogan’s Syndrome. Ann Otol Rhinol Laryngol 2015. [DOI: 10.1177/0003489415595426] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The association of sensorineural hearing loss and vertigo with inflammatory eye disease, usually interstitial keratitis, has been called Cogan’s syndrome. The pathogenesis of Cogan’s syndrome is unknown, but it has been assumed to be an immune mediated disorder with vasculitis. The histopathology of the inner ear in Cogan’s syndrome has been described in 6 case reports. Although common pathologic findings in these reports include degeneration of the auditory and vestibular neuroepithelium, endolymphatic hydrops, fibrosis, and new bone formation, direct pathologic evidence of a vasculitis has not been published. A possible reason for this failure to identify vasculitis was a substantial delay (range, 4-40 years) between the onset of symptoms and examination of the otopathology. In the current case report, the patient had both auditory and vestibular symptoms and interstitial keratitis with a time delay of only 2 to 4 weeks between symptoms and death. Evidence of a vasculitis as a possible underlying etiology included H&E histopathology and anti-CD45 immunostaining of vessels both in the auditory and vestibular systems, supporting the hypothesis of a vasculitis as a mechanism in this disorder.
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Affiliation(s)
- David H. Jung
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph B. Nadol
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Rebecca D. Folkerth
- Harvard Medical School, Boston, Massachusetts, USA
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Joseph F. Merola
- Harvard Medical School, Boston, Massachusetts, USA
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
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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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Vaskulitiden. Herz 2015; 40:85-98. [DOI: 10.1007/s00059-014-4200-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Dolcino M, Lunardi C, Ottria A, Tinazzi E, Patuzzo G, Puccetti A. Crossreactive autoantibodies directed against cutaneous and joint antigens are present in psoriatic arthritis. PLoS One 2014; 9:e115424. [PMID: 25514237 PMCID: PMC4267814 DOI: 10.1371/journal.pone.0115424] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 11/23/2014] [Indexed: 12/24/2022] Open
Abstract
Background Psoriatic arthritis (PsA) is a chronic inflammatory disease of unknown origin, characterized by erosions and new bone formation. Diagnosis of PsA is mainly clinical and there are no biomarkers available. Moreover in PsA autoantibodies have not been described so far. Indeed an autoimmune origin has been suggested but never proven. Aim of the study was to investigate the possible presence of autoantibodies typically associated with PsA. Methods We used pooled IgG immunoglobulins derived from 30 patients with PsA to screen a random peptide library in order to identify disease relevant autoantigen peptides. Results Among the selected peptides, one was recognised by nearly all the patients’ sera. The identified peptide (PsA peptide: TNRRGRGSPGAL) shows sequence similarities with skin autoantigens, such as fibrillin 3, a constituent of actin microfibrils, desmocollin 3, a constituent of the desmosomes and keratin 78, a component of epithelial cytoskeleton. Interestingly the PsA peptide shares homology with the nebulin-related anchoring protein (N-RAP), a protein localized in the enthesis (point of insertion of a tendon or ligament to the bone), which represents the first affected site during early PsA. Antibodies affinity purified against the PsA peptide recognize fibrillin, desmocollin, keratin and N-RAP. Moreover antibodies directed against the PsA peptide are detectable in 85% of PsA patients. Such antibodies are not present in healthy donors and are present in 13/100 patients with seroposive rheumatoid arthritis (RA). In seronegative RA these antibodies are detectable only in 3/100 patients. Conclusions Our results indicate that PsA is characterized by the presence of serum autoantibodies crossreacting with an epitope shared by skin and joint antigens.
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Affiliation(s)
| | | | | | - Elisa Tinazzi
- Department of Medicine, University of Verona, Verona, Italy
| | | | - Antonio Puccetti
- Institute Giannina Gaslini, Genova, Italy
- University of Genova, Genova, Italy
- * E-mail:
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