TITLE:
Undifferentiated Arthritis Revealing Cogan’s Disease
AUTHORS:
Paul Eloundou, Aly Badra Kamissoko, Francine Same Bebey, Marina Sanda, Al Mâmy Aboubakar, William Nguekouo, Abèni Faouziyath Yaya, Mireille Yomba, Severin Noumbissi
KEYWORDS:
Cogan’s Syndrome, Arthritis, Non-Syphilitic Interstitial Keratitis, Bilateral Deafness
JOURNAL NAME:
Open Journal of Rheumatology and Autoimmune Diseases,
Vol.12 No.1,
January
11,
2022
ABSTRACT: Background: Cogan’s syndrome is a rare autoimmune vasculitis (less than 300 cases described in the literature)
characterized in its typical form by cochleovestibular involvement, interstitial keratitis, and an inflammatory
involvement of large vessels. It is frequently accompanied by general
signs and cardio-vascular, rheumatologic, and digestive complications. Its
management is essentially based on the use of corticosteroids and
immunosuppressants. The outcome of the
treatment, even if rapid, does not always avoid functional complications. This disease is probably
under-diagnosed in Africa. Objective: The objective of this study
was to report a case of Cogan syndrome in sub-Saharan Africa. Case report: A 78 year old black African female patient presented with arthritis of the left
knee without fever. The examination also revealed a bilateral deafness of
rapidly progressive onset. The patient was known to be diabetic and
hypertensive, and was regularly monitored. The biology revealed an inflammatory
syndrome and an inflammatory joint puncture fluid. Pure tone audiometry confirmed a 77% hearing loss. The ophthalmological examination revealed stromal oedema and hypertensive
retinopathy of Kendall stage III. The rheumatological evolution was good
under methylprednisolone and methotrexate, but the deafness persisted. The
occurrence of a fever on day 12 of treatment
required further investigations (blood culture, PCR-Covid 19 test,
cytobacteriological examination of sputum, thoracic CT). The evolution was
unfavourable with the death of the patient. Conclusion: Cogan’s disease
is a rare inflammatory disease. Its diagnosis and management are multidisciplinary.
The treatment can be disappointing.