Interstitial keratitis and sensorineural hearing loss in RA:
Cogan's syndrome or non-syphilitic interstitial keratitis with vestibule-auditory dysfunction is a serious and under-recognised complication of rheumatoid arthritis. It is an autoimmune condition characterised by inflammatory infiltrates on the cornea and extensive vestibulocochlear damage.

If left untreated, patients progress to develop profound hearing loss.

The authors present a case that was incorrectly diagnosed and treated as conjunctivitis by several emergency departments prior to being correctly recognised as Cogan's syndrome.

Learning points
• Hearing loss and interstitial keratitis in patients with rheumatoid arthritis should prompt the clinician to think of Cogan's syndrome.

• Early treatment with high-dose steroids is imperative to prevent long-term complications.

• Always discuss with a rheumatologist if uncertainty exists.

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