Cogan氏症候群と思われる一症例

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In 1945 Cogan reported a syndrome consisting of nonsyphilitic keratitis with vestibulo-auditory dysfunction. Since Cogan's original papers were published, more than thirty additional cases have been reported. In Japan, however, no case has yet been reported.We report in this paper a case of a 62-year-old house wife with left interstitial nonsyphilitic keratitis and vestibulo-auditory symptoms.Patient had had recurrent keratitis of left eye for eighteen years and began to have frequent attacks of rotatory vertigo, tinnitus, nausea and headache for the past four years. Hearing loss was also noticed. On September 1963, she had blurred vision and was diagnosed as left interstitial keratitis.At the same time she had frequent episodes of vertigo with nausea, headache, tinnitus and hearing loss.Laboratory tests including hematology, blood chemistry and urinalysis were all normal. Blood serology was negative. ECG indicated left ventricular hypertrophy. She was treated with steroid-antibiotic eye solution and was placed on oral steroid drug. Audiometry showed bilateral sensorineural hearing loss. (Fig. 1) Tracings by Békésy-type audiometer suggested cochlear lesion. (Fig. 2) TTS was negative. Caloric tests revealed directional preponderance to the right. There was a nystagmus by positsonal change. (Fig. 3 and 4) As ophthalmic findings have gradually shown the herpetic lesions, ophthalmic solution (I.D. U.-5-Iodo-2-deoxyuridine and Chloromycetine has been used with some benefit.This case of Cogan's syndrome is unusual in the following points; 1) The rather long interval between the onset of eye and vestibuloauditory symptoms, 2) old age, 3) caloric test which showed directional preponderance to the right and 4) unilateral keratitis.This case has showed no signs and symptoms of systemic disease such as periarteritis nodosa, though she had hypertension and kidney disease in the past. With the increase of the cases, some variations in the signs and symptoms of this syndrome have been appearing. These may be also called as Cogan's syndrome or atypical Cogan's syndrome for the time being, since the etiologic factors not yet been discovered. But in the future we should analyse and classify the case from the etiological point of view.
社団法人日本耳鼻咽喉科学会の論文

Cogan氏症候群と思われる一症例

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