Fever of unknown origin: a challenging case.

Area of Science:

• Rheumatology
• Ophthalmology
• Otolaryngology

Background:

• Cogan's syndrome is a rare autoimmune disorder characterized by non-syphilitic interstitial keratitis and vestibuloauditory dysfunction.
• Early diagnosis and treatment are essential to prevent irreversible damage.

Observation:

• A 31-year-old woman presented with prolonged fever of unknown origin, constitutional symptoms, rash, episcleritis, dizziness, and sensorineural hearing loss.
• Initial investigations failed to yield a diagnosis, highlighting diagnostic challenges.

Findings:

• The patient's constellation of symptoms, including vasculitic rash and audiovestibular/ocular involvement, led to a clinical diagnosis of Cogan's syndrome.
• Symptomatic improvement following immunosuppressive therapy confirmed the diagnosis.

Implications:

• This case underscores the importance of recognizing Cogan's syndrome in patients with unexplained fever and multi-systemic inflammatory signs.
• Timely immunosuppressive treatment can prevent severe complications such as hearing loss and vision impairment.