Vestibulocochlear disease – diagnostic proceeding at a case with uncommon reason

Introduction:

Patients with vestibulocochlear dysfuntion that show additional symptoms may have neurological or rheumatological diseases or a special infection as differential diagnosis.

Case history:

A 21 year old patient presented with rotational vertigo, hearing loss at both sides and tinnitus. 3 weeks bevor, the same symptoms occurred and were treated with corticosteroids. Cerebral MRI was normal. Serological test showed positive Herpes Simplex Virus-IgM. Therefore the patient received virostatic therapy and again cortikosteroids. 5 days after pausing corticosteroids, hearing loss reappeared. Additionally, the patient showed conjunctival flush of both eyes and neck pain. Neurologic disease as meningitis, central HSV-infection and encephalitis because of viral infection after vacation by the sea in Egypt (Flavivirus) was excluded. The conjunctival flush was diagnosed as episcleritis. Therefore, systemic cause was looked for although autoimmune serological tests were negative. In cooperation with rheumatologists, atypic cogan syndrome with differential diagnosis ANCA-negative vasculitis was believed as reason. Over time, oculists diagnosed interstitial keratitis, thus typic Cogan-Syndrome was diagnosed. The patient received highly dosed cortisone. The symptoms regressed very fast.

Conclusion:

Cogan syndrome is a diagnosis of exclusion. The cross-disciplinary cooperation of several disciplines can show up and exclude possible differential diagnoses.

Publication History

Publication Date:
12 June 2019 (online)