To report a case of sarcoidosis that mimic Cogan syndrome
Methods
A 25 year old lady developed red eye bilaterally. For several months, she had night sweating and fever and later erythema nodosum and polyarthritis were added to her problems. NSAIDs and low dose prednisone helped her symptoms, although her eyes were constantly inflamed and diagnosed with interstitial keratitis. Later he flared with arthritis and dyspnea. CT scan revealed pleural effusion and abdominal lymphadenopathy. Although the result of biopsy of the lymph nodes was suggestive of malignant lymphoma, another biopsy of her enlarged spleen revealed granuloma lesion. As the PCR of the tissue was negative for Mycobacterium Tuberculosis, the diagnosis of sarcoidosis was put as the first diagnosis. Blood tests ordered for screening sarcoidosis such as ACE, calcium, lysozyme, AST, ALT were within normal limits, although LDH was highly elevated. In spite of immunomodulatory therapy which controlled her eye problems (Figure 1 & 2) completely, she developed a neurosensory hearing loss due to CN VIII involvement that was not amenable to immunosuppressives.
Results
Although mediastinal lymphadenopathy or pulmonary parenchymal involvement was missing from the triad of Lofgren syndrome in our patient, the presence of granulomatous inflammation in addition to other findings was highly suggestive of diagnosis of sarcoidosis. The limited presence of granuloma could be the reason for normal ACE levels in blood. Her ocular symptoms including interstitial keratitis and low grade uveitis improved with methotrexate and adalimumab.
Conclusion
Sarcoidosis can mimic Cogan Syndrome. Limited granuloma formation may prevent elevated levels of ACE in the blood.
Conflict of interest
No
Author 1
Last name
EBRAHIMIADIB
Initials of first name(s)
N
Department
Ophthalmology
City
Tehran
Country
Iran
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