Posters

Case report: ocular disease in Cogan’s syndrome

Poster Details

First Author: H. Sillen BELGIUM

Co Author(s): I. Leysen   C. Koppen   E. Smets              

Abstract Details

Purpose:

To report a case of Cogan’s syndrome with ocular signs in a patient with a wide range of general symptoms.

Setting:

Antwerp University Hospital, Belgium

Methods:

A 29-year-old Indonesian woman presented with bilateral ocular redness, pain and intermittent vision loss since one year. Slit lamp examination revealed bilateral stromal keratitis with stromal neovascularisation. Funduscopic and fluoangiographic findings were normal. Takayasu’s disease had been diagnosed shortly before this contact, while bilateral hearing loss on an autoimmune basis preceded the ocular symptoms by four years. Considering the full clinical spectrum the diagnosis of Cogan’s syndrome was made. The patient was treated with oral cyclophosphamide and topical corticosteroids. Several months later she developed a left-sided postganglionic Horner’s syndrome because of occlusion of the left subclavian artery.

Results:

Cogan’s syndrome is a rare idiopathic chronic inflammatory disease of the eye and the inner ear in young adults. It is characterised by ocular symptoms (redness, photophobia, blurred vision), ocular signs (peripheral stromal opacities, neovascularisation and in some cases uveitis, scleritis and retinal vasculitis) in combination with vestibuloauditory abnormalities (deafness, tinnitus and vertigo). Association between Cogan’s syndrome and systemic features, such as Takayasu’s disease, has been described in 30% of the patients. In rare cases total occlusion of the subclavian artery can cause a postganglionic Horner’s syndrome.

Conclusions:

This case report describes a patient with Takayasu’s disease and hearing loss, who now presented with ocular symptoms. Because of the new finding of interstitial keratitis, the diagnosis of Cogan’s syndrome was made. Diagnosing this syndrome was difficult because the ocular signs occurred four years after the initial signs of hearing loss. Horner’s syndrome based on systemic vasculitis made this case even more challenging. This emphasises the necessity of a multidisciplinary approach in patients with Cogan’s syndrome.

Financial Disclosure:

None