BMJ Case Reports 2018; doi:10.1136/bcr-2017-224031
  • Rare disease

Fever of unknown origin: a challenging case

Open Access
  1. Charles Mallia Azzopardi3
  1. 1 Medicine, Mater Dei Hospital, Msida, Malta
  2. 2 Rheumatology, Mater Dei Hospital, Msida, Malta
  3. 3 Infectious Diseases, Mater Dei Hospital, Msida, Malta
  1. Correspondence to Dr Sarah Vella, smv2610{at}
  • Accepted 15 May 2018
  • Published 4 June 2018


We report a case of Cogan’s syndrome presenting as fever of unknown origin in a 31-year-old woman who was admitted to the hospital with a 7-week history of fever, night sweats and other constitutional symptoms. The diagnosis remained elusive despite numerous investigations, and the patient subsequently developed rash, episcleritis, dizziness and sensorineural hearing loss. While initially thought to be a postinflammatory response to a previous infection, confirmation of the rash as a vasculitis together with the audiovestibular and ocular involvement led to a clinical diagnosis of Cogan’s syndrome. This was further corroborated by resolution of her symptoms once immunosuppressive therapy was instituted. Early recognition of Cogan’s syndrome is crucial to reducing the risk of serious complications through the timely initiation of treatment.


  • Contributors SV was responsible for the literature review and manuscript preparation. BC and CMA contributed towards review and editing of the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Open Access

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog

Navigate This Article