1
|
Kumagai N, Oikawa Y, Nakayama M, Kasajima A, Joh K. A pediatric case of Cogan's syndrome with tubulointerstitial nephritis and vasculitis: lessons for the clinical nephrologist. J Nephrol 2024:10.1007/s40620-024-01898-8. [PMID: 38512369 DOI: 10.1007/s40620-024-01898-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/10/2024] [Indexed: 03/23/2024]
Affiliation(s)
- Naonori Kumagai
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan.
- Department of Pediatrics, Fujita Health University School of Medicine, 1-98, Dengakugakubo, Kutsukakecho, Toyoake-Shi, Aichi-Ken, 470-1192, Japan.
| | - Yoshitsugu Oikawa
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Makiko Nakayama
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Japan
| | - Atsuko Kasajima
- Department of Anatomic Pathology, Tohoku University School of Medicine, Sendai, Japan
| | - Kensuke Joh
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
2
|
Lu C, Lv P, Zhu X, Han Y. Cogan's Syndrome Combined with Hypertrophic Pachymeningitis: A Case Report. J Inflamm Res 2024; 17:1839-1843. [PMID: 38523688 PMCID: PMC10961085 DOI: 10.2147/jir.s453071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 03/12/2024] [Indexed: 03/26/2024] Open
Abstract
Cogan's syndrome (CS) is a rare chronic inflammatory disease, characterized by interstitial keratitis and vestibular auditory dysfunction. Hypertrophic pachymeningitis (HP) is a rare chronic aseptic inflammatory disease of the central nervous system. This article reports a patient with CS coexisting with HP. The patient was a 66-year-old male with fever, headache, red eyes, hearing loss, and significantly elevated inflammatory markers. Cerebrospinal fluid examination, blood culture, and tests for autoantibodies such as antinuclear antibodies were negative. Pure tone audiology (PTA) indicated bilateral sensorineural deafness. Both Positron emission tomography-computed tomography (PET/CT) and vascular color Doppler ultrasound suggest the presence of vasculitis. Considering Cogan's syndrome, the patient received 40 mg of methylprednisolone intravenously once daily. The brain's magnetic resonance imaging (MRI) revealed slightly thickened and enhanced dura mater, suggesting HP. The dose of methylprednisolone was increased to 40 mg intravenously every 8 hours, leading to the patient's improved symptoms and decreased inflammatory markers. Both CS and HP are rare chronic inflammatory diseases, and their coexistence is even rarer, with only two reported cases in literature up to date. The coexistence of CS and HP should be considered when the CS patients with headaches do not respond well to treatment.
Collapse
Affiliation(s)
- Ci Lu
- Department of Rheumatology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Panpan Lv
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Xiaoying Zhu
- Department of Rheumatology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Yongmei Han
- Department of Rheumatology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| |
Collapse
|
3
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
4
|
Lifson N, Rana V, Maher L, Snady-McCoy L. Posterior Scleritis: A Unique Sequela of Cogan Syndrome. R I Med J (2013) 2022; 105:32-33. [PMID: 35881997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Nicole Lifson
- Department of Ophthalmology, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Viren Rana
- Department of Ophthalmology, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Lewena Maher
- Department of Rheumatology, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Lory Snady-McCoy
- Department of Ophthalmology, The Warren Alpert Medical School of Brown University, Providence, RI
| |
Collapse
|
5
|
Venhoff N, Thiel J, Schramm MA, Jandova I, Voll RE, Glaser C. Case Report: Effective and Safe Treatment With Certolizumab Pegol in Pregnant Patients With Cogan's Syndrome: A Report of Three Pregnancies in Two Patients. Front Immunol 2021; 11:616992. [PMID: 33537034 PMCID: PMC7847974 DOI: 10.3389/fimmu.2020.616992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/30/2020] [Indexed: 12/16/2022] Open
Abstract
Cogan's syndrome is a rare autoimmune disease characterized by ocular inflammation and audiovestibular manifestations. Treatment consists of systemic glucocorticoids and other immunosuppressive agents including methotrexate, cyclophosphamide and TNF-α-inhibitors. Due to potential ovarian or fetal toxicity immunosuppressive treatment options are limited during pregnancies. Thus far there is a paucity of reports on pregnancies in Cogan's syndrome. With minimal transplacental transfer, Certolizumab pegol is considered to be safe for the use in pregnant patients with underlying inflammatory diseases. However, there is no literature on the use of this TNF-α-inhibitor in Cogan's syndrome in general and especially during gestation. Here we report three pregnancies in two Cogan's Syndrome-patients treated with Certolizumab pegol. Treatment with Certolizumab pegol was effective and well tolerated in patients with Cogan's syndrome and seems to be a safe treatment option during pregnancy.
Collapse
Affiliation(s)
- Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | | | | | | | | | | |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
|
9
|
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: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| | | |
Collapse
|
10
|
Kalogeropoulos C, Karachalios D, Pentheroudakis G, Tsikou-Papafrangou A, Abou-Asabeh L, Argyropoulou M, Drosos A, Pavlidis N. Development of a low grade lymphoma in the mastoid bone in a patient with atypical Cogan's syndrome: A case report. J Adv Res 2014; 6:523-7. [PMID: 26257951 PMCID: PMC4522542 DOI: 10.1016/j.jare.2014.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 05/09/2014] [Accepted: 05/12/2014] [Indexed: 11/25/2022] Open
Abstract
Cogan’s syndrome is a rare disorder characterized by ocular and audiovestibular manifestations in its typical form and caries a wide variety of atypical manifestations. It is considered as an autoimmune disease. We present the first case in the literature of a 67 year old woman with the development of low grade non-Hodgkin lymphoma (NHL) in the mastoid bone in a pre-existing history of atypical Cogan’s syndrome. The anatomical development of NHL was to a “target” organ of Cogan’s syndrome, which is the inner ear.
Collapse
Affiliation(s)
- Chris Kalogeropoulos
- Department of Opthalmology, Ioannina University Hospital, S. Niarchos Avenue, Ioannina 45500, Greece
| | - Dimitrios Karachalios
- Department of Medical Oncology, Ioannina University Hospital, S. Niarchos Avenue, Ioannina 45500, Greece
| | - George Pentheroudakis
- Department of Medical Oncology, Ioannina University Hospital, S. Niarchos Avenue, Ioannina 45500, Greece
| | | | - Lydia Abou-Asabeh
- Department of Pathology, Red Cross General Hospital, Athanasaki 1 & Red Cross Str, Athens 11526, Greece
| | - Maria Argyropoulou
- Department of Radiology, Ioannina University Hospital, S. Niarchos Avenue, Ioannina 45500, Greece
| | - Alexandros Drosos
- Department of Rheumatology, Ioannina University Hospital, S. Niarchos Avenue, Ioannina 45500, Greece
| | - Nicholas Pavlidis
- Department of Medical Oncology, Ioannina University Hospital, S. Niarchos Avenue, Ioannina 45500, Greece
| |
Collapse
|
11
|
Migliori G, Battisti E, Pari M, Vitelli N, Cingolani C. A shifty diagnosis: Cogan's syndrome. A case report and review of the literature. Acta Otorhinolaryngol Ital 2009; 29:108-13. [PMID: 20111622 PMCID: PMC2808685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Accepted: 03/06/2008] [Indexed: 05/28/2023]
Abstract
Cogan's syndrome is defined as a chronic inflammatory disease of unknown origin, an autoimmune disease, characterized by bilateral sensorineural hearing loss, vestibular symptoms, inflammatory ocular manifestations with variable risk of developing into a systemic disease. The onset of disease is variable but is often characterized by isolated ocular symptoms or acute ear and/or vestibular manifestations, variably associated. The diagnosis of Cogan's syndrome can be a challenge as is evident in the case described here since it is based only on the association between bilateral ocular and vestibuloauditory symptoms with no specific diagnostic tests available.
Collapse
Affiliation(s)
- G Migliori
- Department of Otorhinolaryngology, Santa Croce Hospital, Fano, Italy
| | | | | | | | | |
Collapse
|