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CASE REPORT
Cogan’s syndrome with pyoderma gangrenosum: management of two uncommon disorders with aggressive presentation in a patient
  1. Ezolene Pei-Chin Chua1,
  2. Richard B Mallett2,
  3. Sandeep Dahiya1
  1. 1Department of Rheumatology, Peterborough City Hospital, Peterborough, United Kingdom
  2. 2Department of Dermatology, Peterborough City Hospital, Peterborough, United Kingdom
  1. Correspondence to Dr Ezolene Pei-Chin Chua, ezolene.chua{at}gmail.com

Summary

Pyoderma gangrenosum (PG) coexisting with Cogan’s syndrome (CS) is uncommon, although cutaneous manifestations are known to develop in CS. A middle-aged white female patient had chronic relapsing PG requiring ciclosporin and prednisolone. Despite receiving optimal doses of ciclosporin and prednisolone, she developed acute vestibulo-auditory symptoms as a result of CS. Ciclosporin was switched to methotrexate and prednisolone was increased. However, she continued to develop acute scleritis, requiring methylprednisolone pulses, and still had further flares of PG. Her methotrexate was held off when she developed severe pneumonia and she then received a trial of intravenous immunoglobulins (IVIG) for her recurrent leg ulcers. Unfortunately, she failed to respond to IVIG. Her ulcers eventually responded to six doses of monthly intravenous cyclophosphamide induction. Although CS is not an antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis, we used pulse cyclophosphamide, based on the experience of cyclophosphamide efficacy in severe ANCA-associated vasculitis (AAV). Following induction, both diseases currently remain under control with azathioprine as maintenance treatment.

  • vasculitis
  • dermatology
  • ophthalmology
  • ear, nose and throat/otolaryngology

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Footnotes

  • Contributors SD and RM managed the patient. SD proposed to write the case as a learning point. EC retrieved the patient’s clinical data, drafted the manuscript and arranged the final edition following advice on suggested changes by SD and RM. EC is the corresponding doctor.

  • 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.

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