Jornal de Oftalmologia Clínica e Experimental
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Systemic Sarcoidosis Mimicking Cogan's Syndrome: A Case Report

Elahe Havashki, Mehran Zarei-Ghanavati, Hoda Kavosi, Zohre Ebrahimi, Sanaz Naybandi, Nazanin Ebrahimiadib

Purpose: To report a case of non-pulmonary sarcoidosis involving cornea and cranial nerve VIII

Case: A 25-year-old lady initially presented with flu-like symptoms, erythema nodosum and polyarthritis of minor joints. She later developed abdominal lymphadenopathy and splenomegaly. Spleen biopsy revealed granulomatous inflammation. There was a chronic ocular inflammation due to interstitial keratitis, which responded partially to topical corticosteroid and tacrolimus. Corneal infiltrations healed with the aid of immunomodulatory agents. Later, she developed neurosensory hearing loss due to inflammation of Cranial Nerve (CN) VIII. All her symptoms except neurosarcoidosis has improved with systemic azathioprine, and then oral methotrexate and subcutaneous anti TNF alpha.

Conclusion: Interstitial keratitis and involvement of CN VIII are rare manifestations of sarcoidosis. This clinical picture resembles Cogan's syndrome. Ocular manifestations of a systemic autoimmune disease are best managed by appropriate immunodulatory therapy.