Date Clinical Event Intervention/Treatment
July 28, 2022 Sudden onset of vertigo, dizziness, vomiting, and a heavy head sensation
Treated with betahistine and antiemetics; advised to perform vestibular exercises
August 7, 2022 Severe left eye pain with redness, watery discharge, and blurred vision
Initiated on acyclovir 400 mg (5 tablets/day for 1 week with taper) and prednisolone 1% eye drops (every 2 hours, tapered over time)
August 29, 2022 Onset of left ear hearing loss, persistent tinnitus, and ear pain
Referred to ENT; initial diagnosis of Meniere’s disease; started on oral prednisone 50 mg/day and betahistine (later discontinued due to intolerance)
August 30, 2022 Complete left ear hearing loss noted; emergency department evaluation conducted CT head and temporal bone studies were normal;
discharge instructions provided from Windsor Regional Hospital (see DischargeSummary3Nov22.pdf and ER report)
September 1, 2022 ENT re-assessment revised diagnosis to Cogan’s syndrome based on the history of interstitial keratitis and sudden sensorineural hearing loss
Intratympanic dexamethasone injection administered to the left ear; oral prednisone continued
September 6, 2022 Due to ongoing symptoms,
hyperbaric oxygen therapy was initiated Scheduled for 20–30 sessions
October 2022 MRI (ENT request) performed: Findings included T1/FLAIR hyperintensity in the left cochlea, vestibule, and semicircular canals (suggestive of intralabyrinthine hemorrhage),
CT temporal bone studies were normal; additional ENT and ophthalmologic evaluations were performed
November 2022 Discharge summary from hospital documented stabilization of ocular symptoms and ongoing vestibular issues
Patient discharged with instructions for outpatient follow-up and continuation of immunosuppressive therapy
January 2024 Rheumatology follow-up: Patient noted absence of active eye inflammation; however, persistent dizziness (described as “shaky and blurry vision when looking into the distance” with a sensation of head fullness) and hearing difficulties remain, particularly in the left ear
Medications at this visit included Remicade (Infliximab) 300 mg IV q6 weeks, methotrexate 20 mg PO weekly, folic acid, alendronate, and low–dose prednisone (5 mg every other day); hearing aids were trialed but not tolerated
March 2024 & Sept 2023 Subsequent follow-up visits (as per SB March 7 and SB Sept 29 reports) documented stable laboratory markers and no new systemic involvement
Continued immunosuppressive regimen with close monitoring; labs ordered every three months
October 2024 Latest follow-up: Inflammatory markers remain normalized; vasculitis appears in remission; vestibular symptoms have improved, though the left ear remains profoundly deaf.
Prednisone discontinued; patient remains on Remicade, methotrexate, and folic acid. MRI follow-up (scheduled per SB MRI Jan 6 and ongoing) confirms stable inner ear findings
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