Introduction. Cogan's syndrome is a rare variable vessel vasculitis. It can be typical and atypical. Basis of the treatment comprises glucocorticoids, and in patients with systemic manifestations, immunosuppressive drugs. Case report. We wanted to present the experience of the Clinic for Rheumatology and Clinical Immunology of the Military Medical Academy, Belgrade, in diagnosing and treating patients suffering from Cogan's syndrome. The analysis included 7 patients. Patients' demographic characteristics, disease manifestations, course of the disease, applied treatment and treatment outcome were analysed. Five of the patients were women and 2 were men, with the average age of 39 ± 13 (25-65) years. The typical form of the disease manifested in 1 patient. In 6 patients, the first manifestation was the audiovestibular dysfunction. In 1 patient, systemic manifestations were the first to appear. In the cases where the disease manifested atypically, 3 patients developed conjunctivitis, 2 episcleritis, and 1 uveitis. They all had systemic manifestations. One female patient was diagnosed with aortitis and aortic insufficiency. They all tested positive for inflamma-tory biohumoral syndrome. Four patients had positive antinuclear antibodies, 3 anticytoplasmic antibodies, and 1 positive rheumatoid factor. They were all treated with glucocorticoid and immunosuppressive drugs. Methotrexate was administered to all the patients in doses up to 20 mg per week. Pulses of cyclophosphamide were administered to 2 female patients. All patients went successfully into remission. The female patient with the typical form of the disease experienced permanent bilateral hearing loss. Conclusion. Patients with a rapidly developed audiovestibular dysfunction should be viewed as suffering from Cogan's syndrome from the viewpoint of differential diagnosis. A timely treatment with glucocorticoids can prevent hearing loss and the development of systemic manifestations of the disease. Precedence should be given to methotrexate when selecting an immunosuppressive drug.
Background/Aim. Systemic sclerosis (SSc) is a chronic systemic disease of the connective tissue. It is characterized by diffuse microangiopathy, increased activity and creating deposits of collagen in the skin and internal organs. Involvement of the lung function disturbances in SSc is a bad prognostic sign. The aim of our study was to investigate the association between smoking habits and lung function disorder in the SSc patients. Methods. The testing was conducted at the Clinic for Rheumatology and Immunology of the Military Medical Academy in 2016. In this study, we included 42 patients with the newly diagnosed SSc and the patients whose disease had been diagnosed earlier. Results. The patients were classified according to the smoking habits, 14 (33.3%) patients were nonsmokers, while 28 (66.7%) patients were current (23 patients) or ex-smokers (5 patients). We found no significant differences in examined parameters among smokers and nonsmokers. In addition, distribution of the patients with the obstructive pulmonary pattern revealed by spirometry was uniform between smokers and nonsmokers. The concentrations of C reactive protein (CRP) were significantly higher in the SSc patients with the obstructive pulmonary pattern. The patients with the obstructive pattern on spirometry had significantly lower values of forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC ratio, diffusing lung capacity for carbon monoxide (DLCO) and FVC/DLCO ratio. Conclusion. In our study, we concluded that in the SSc patients with the obstructive pulmonary pattern revealed by spirometry, there were no significant differences between smokers and nonsmokers. CRP is a significant predictor of the lung involvement existence in the SSc patients.
Introduction. Thymus plays an important role in the maturation of T-lymphocytes and in the development of immune tolerance. Its involution comes after puberty. If thymic tissue remains preserved in an advanced age it is considered to be the thymus persistens. According to the available data, 5% of patients with a thymoma have some of the autoimmune disorders. Medical data on the systemic lupus erythematosus (SLE) association with the thymus persistens are scarce. Case report. A 29-year-old patient was diagnosed with SLE at the age of 12. She was treated with continuous doses of corticosteroids and an antimalarial drug (chloroquine). After ten years, the first, and then two more recurrences of the disease with the last recurrence in 2011 occurred. The performed laboratory analyses indicated the disease activity. The radiography of thorax showed a change on the right lung, with enlarged mediastinal shadow. Therefore the multislice computed tomography (MSCT) of thorax was made. The pathohistology findings confirmed that the change on the right lung was focus of chronic pneumonitis, while the change in mediastinum was thymus persistens. The thymectomy was performed. Due to pneumonitis, the treatment of SLE was continued with corticosteroids, antimalarial drug and pulse doses of cyclophosphamide. The patient received six monthly and six quarterly pulsed doses of the drug. The remission of the disease maintained all the time. Conclusion. The disorder of thymic function should be considered as a possible cause in the development of SLE. Though the effect of thymectomy is difficult to assess, patients should be carefully monitored.
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