Cogan syndrome following SARS-COV-2 infection

Excerpt

A 61-year-old man presented with a 2-month history of tinnitus, progressive hearing loss, and a 2-week history of generalized joint pain, blurred vision, and redness in both eyes. He also had a high fever for the first 2 days and a positive PCR test for SARS-COV-2 RNA. On admission, he was afebrile, and the physical examination revealed bilateral conjunctival congestion (Fig. 1A). The right knee and interphalangeal joints were swollen and tender. A laboratory evaluation showed elevated CRP (19 mg/L) and ESR (40 mm/h). Autoantibodies (such as ANA, ENA, and ANCA) and pathogen examinations including treponema pallidum were negative. The audiometry indicated moderate to severe mixed deafness, and the internal otoscopy revealed left-sided secretory otitis media. Similarly, the MRI showed left-side otitis media and mastoiditis (Fig. 1B). Based on these data, we diagnosed Cogan syndrome (CS) after excluding syphilis, ANCA-associated vasculitis and other autoimmune diseases. With high-dose methylprednisolone (120 mg daily), his hearing and vision improved. After the tapering of glucocorticoid, he was treated with intravenous cyclophosphamide monthly, and the symptoms ameliorated significantly.

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