-Case Reports-

Cutaneous Vasculitis in Cogan's Syndrome: A Report of Two Cases Associated with Chlamydia Infection

Yushi Kawasaki¹, Takashi Uehara² and Seiji Kawana³

¹Department of Dermatology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
²Department of Respiratory Medicine, Yokosuka General Hospital, Kanagawa, Japan
³Department of Dermatology, Nippon Medical School, Tokyo, Japan

Cogan's syndrome (CS) is defined by the combination of hearing loss, vertigo, and ocular inflammation of uncertain cause, and can be associated with variable vessel vasculitis. Vasculitic manifestations may include arteritis (affecting large, medium or small arteries), aortitis, and aortic and mitral valvulitis. Cutaneous manifestations including erythema, papules, subcutaneous nodules, and purpura sometimes occur; however, to date, only six cases have been histologically confirmed to have genuine vasculitis. Here, we report two cases of CS, one of which involved a patient who developed the typical symptoms of Takayasu arteritis and purpuric lesions in the legs, with histologic findings consistent with small vessel vaculitis in the dermis. The second case involved a patient who developed subcutaneous nodules in the legs and the axilla, and histologic findings revealed a necrotizing vasculitis of the small arteries in the interlobular area. Both cases were successfully treated with systemic steroid therapy. Based on the clinical features and the examination data, there is a possibility that a Chlamydia trachomatis infection played a pivotal role in the pathogenesis of those vasculitides.

J Nippon Med Sch 2018; 85: 172-177

Keywords
Cogan's syndrome, small vessel vasculitis, cutaneous polyarteritis nodosa, Chlamydia trachomatis, heat shock protein

Correspondence to
Yushi Kawasaki, MD, PhD, Department of Dermatology, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamakari, Inzai, Chiba 270-1694, Japan
yushikawasaki@hotmail.com

Received, November 9, 2017
Accepted, November 22, 2017