Cogan syndrome

Page most recently updated 7 September 2026

This page focuses on the reported psychiatric associations, which may be the initial presenting manifestation, and on other clinical features that may assist the psychiatrist or primary care physician in identifying the underlying diagnosis, considered through the lenses of the diagnostic lenses framework.

Cogan syndrome is a systemic vasculitis.

It can present with psychiatric features such as depression, anxiety, cognitive dysfunction, mood disturbance, behavioural change, and, less commonly, psychosis.

Other characteristic features include interstitial keratitis causing eye pain, redness, photophobia, and visual disturbance; audiovestibular dysfunction resembling Ménière disease with sensorineural hearing loss, tinnitus, vertigo, and imbalance; and, less commonly, neurological manifestations such as headache, peripheral neuropathy, seizures, or cerebrovascular events. Distinctive features include the combination of inflammatory eye disease and audiovestibular involvement, with systemic vasculitis occurring in some patients.

From a multisystemic lens perspective, clinical features in other body systems include (but are not limited to):

  • Cardiovascular: systemic vasculitis may involve the aorta and large vessels, with aortitis, aneurysm formation, and valvular involvement (including aortic regurgitation) occurring in some patients.

  • Musculoskeletal: arthralgia, myalgia, and inflammatory arthritis may occur.

  • Dermatologic: erythema nodosum, urticaria, and other inflammatory skin manifestations may occur.

Early diagnosis is important to enable prompt immunosuppressive therapy, prevent irreversible visual impairment and permanent sensorineural hearing loss, identify and manage systemic vasculitic complications, and improve long-term prognosis and quality of life.

Selected references and further reading — Multisystemic lens

Cardinal RN, Bullmore ET. The diagnosis of psychosis. Cambridge: Cambridge University Press; 2011.

Sachdev PS, Keshavan MS, editors. Secondary schizophrenia. Cambridge: Cambridge University Press; 2010.

Levenson JL, editor. The American Psychiatric Association Publishing textbook of psychosomatic medicine and consultation-liaison psychiatry. 3rd ed. Washington (DC): American Psychiatric Association Publishing; 2019.

Stern TA, Beach SR, Smith FA, Freudenreich O, Vranceau AM, Fava M, editors. Massachusetts General Hospital handbook of general hospital psychiatry. 8th ed. Philadelphia: Elsevier; 2025.

Arciniegas DB, Yudofsky SC, Hales RE, editors. The American Psychiatric Association Publishing textbook of neuropsychiatry and clinical neurosciences. 6th ed. Washington (DC): American Psychiatric Association Publishing; 2018.

Agrawal N, Faruqui R, Bodani M, editors. Oxford textbook of neuropsychiatry. Oxford: Oxford University Press; 2020.

Boland R, Verduin M, editors. Kaplan and Sadock's comprehensive textbook of psychiatry. 11th ed. Philadelphia: Wolters Kluwer; 2024.

Loscalzo J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Harrison's principles of internal medicine. 22nd ed. New York: McGraw Hill; 2025.