Interstitial Keratitis in Cogan’s Syndrome
A 24-year-old woman who had a 10-year history of intermittent episodes of redness and photophobia in both eyes presented to the ophthalmology clinic with visual changes. On examination, the visual acuity was 20/30 in the right eye and 20/25 in the left eye. Slit-lamp examination revealed conjunctival hyperemia and peripheral corneal opacification, with inflammation and crystalline deposits on the corneal stroma, findings that are consistent with interstitial keratitis. Syphilis is a leading cause of interstitial keratitis, but a variety of other infections (e.g., herpes simplex virus infection and tuberculosis) and autoimmune disorders can cause it as well. The erythrocyte sedimentation rate was elevated at 39 mm per hour (normal value, <21 mm per hour), and evaluation for infectious causes was unremarkable. Six months after the diagnosis of interstitial keratitis was made, the patient reported having vertigo, tinnitus, and hearing loss. Audiometry revealed moderate sensorineural hearing loss in both ears. This constellation of clinical findings was consistent with Cogan’s syndrome, an inflammatory disorder characterized by interstitial keratitis and vestibuloauditory dysfunction. Treatment with systemic glucocorticoids was initiated. One month later, the patient’s visual acuity was 20/25 in the right eye and 20/20 in the left eye. Audiographic results showed mild sensorineural hearing loss in both ears.
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