Cogan-ov sindrom – serija slučajeva
Abstract
Uvod. Cogan-ov sindrom je zajedno sa Behcet-ovim sindromom prema najnovijoj klasifikaciji svrstan u grupu posebnih vaskulitisnih sindroma. Može biti tipičan i atipičan. Osnov lečenja čine glukokortikoidi, a kod bolesnika sa sistemskim manifestacijama i imunosupresivi. Prikaz slučaja. Prikazali smo iskustvo Klinike za reumatologiju i kliničku imunologiju Vojnomedicinske akademije, Beograd, u dijagnostici i lečenju bolesnika sa Cogan-ovim sindromom. Analizom je obuhvaćeno sedam bolesnika dijagnostikovanih i lečenih u periodu od 2004. do 2016. godine. Analizirane su demografske karakteristike obolelih, manifestacije i tok bolesti do dijagnoze, primenjena terapija i ishod lečenja. Od ukupno sedam bolesnika pet su bile žene i dva muškarca, prosečne životne dobi od 39 ± 13 (25–65) godina. Tipičnu formu bolesti imao je jedan, a atipičnu 6 bolesnika. Kod šest bolesnika prva manifestacija bolesti bile su vrtoglavica i naglo slabljenje sluha. Samo kod jednog bolesnika prvo su se ispoljile sistemske manifestacije. U slučajevima atipičnog Cogan-ovog sindroma tri bolesnika su imala konjuktivitis, dva episkleritis i jedan uveitis. Svi bolesnici imali su sistemske manifestacije. Kod jedne bolesnice dijagnostikovan je aortitis sa posledičnom insuficijencijom aortne valvule. Svi bolesnici imali su pozitivan zapaljenski biohumoralni sindrom. Tri bolesnika imala su pozitivna antinuklearna antitela a dva perinuklearna anticitoplazmatska antitela. Svi su lečeni glukokortikoidima i imunosupresivnim lekovima. Metotreksat je primenjen kod šest bolesnika u dozi do 20 mg nedeljno. Pulsne doze ciklofosfamida primenjene su kod dve bolesnice. Kod svih bolesnika postignuta je remisija bolesti. Kod bolesnice sa tipičnom formom bolesti gubitak sluha bio je obostran i trajan. Zaključak. Bolesnike sa naglo nastalom audiovestibularnom disfunkcijom uvek treba diferencijalno dijagnostički posmatrati kao Cogan-ov sindrom. Na vreme započeta terapija glukokortikoidima može sprečiti gubitak sluha i razvoj sistemskih manifestacija bolesti. Među imunosupresivnim lekovima prednost treba dati metotreksatu.
References
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