Authors: H Balink G A W Bruyn
Publish Date: 2007/07/18
Volume: 26, Issue: 12, Pages: 2177-2179
Abstract
We report on the case of a 60yearold woman with complaints of fatigue coughing anorexia atypical chest pain recurrent fever and also ear pain and hearing loss A test for antineutrophil cytoplasmic antibody ANCA was myeloperoxidase positive with pANCA specificity Laboratory acute phase parameters were increased A 2deoxy218Ffluorodglucose positron emission tomography/computed tomography investigation showed pathological uptake in the aorta ascendens with no other involvement of the large vessels After therapy with methylprednisolon intravenously and later prednisolon orally with methothrexate her general condition and hearing loss improved both subjectively and objectively “Atypical” Cogan’s syndrome was diagnosed on the basis of sensorineural deafness with improvement on steroids and largevessel vasculitis of the aortic archIn “typical” Cogan’s syndrome the presence of interstitial keratitis is necessary the term “atypical” Cogan’s syndrome is used when other types of inflammatory eye disease including conjunctivitis uveitis scleritis and choroiditis are associated with the vestibuloauditory abnormalities 2 In many cases the symptomatology is not only restricted to the eyes and the ears but also other organs thus resembling systemic vasculitis in one third of the patients The most common symptoms are cardiovascular musculoskeletal neurological gastrointestinal and mucocutaneous 3Positron emission tomography PET with 2deoxy218Ffluorodglucose FDG is becoming increasingly important in diagnosis staging and therapy monitoring in clinical oncology and has recently been used in the diagnosis of infectious diseases with elevated intracellular glucose metabolism Activated inflammatory cells have been shown to overexpress glucose transporters and to accumulate increased amounts of glucose and structurally related substances such as F18FDG 4 5A 60yearold Caucasian woman was admitted to the hospital with a 4month history of excessive fatigue coughing anorexia and weight loss night sweats and atypical chest pain She also experienced short periods of fever She experienced headaches and ear pain and hearing loss for over the last month mainly on the left side and felt sometimes dizzy No blurred vision complaints or eye problems were noted She was not known with any allergies
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