Objectives. To study the diagnostic value of pleural fluid cholesterol in differentiating transudative and exudative pleural effusion. To compare pleural fluid cholesterol level for exudates with Light's criteria. Design. Cross sectional descriptive study. Settings. Medical wards of Tribhuvan University Teaching Hospital. Methods. Sixty two cases of pleural effusion with definite clinical diagnosis admitted in TUTH were taken and classified as transudates (19) and exudates (43). The parameters pleural fluid protein/serum protein ratio (pfP/sP), pleural fluid LDH/ serum LDH ratio, pleural fluid LDH (pfLDH) and pleural fluid cholesterol (pCHOL) were compared with clinical diagnosis with regard to their usefulness for distinguishing between pleural exudates and transudates. Results. The pCHOL values determined were 1.92 ± 0.75 for exudates, 0.53 ± 0.28 for transudates, the differences between the transudates and others are statistically significant (P < 0.0001). It is seen that pfP/sP ratio has a sensitivity of 81.4% and specificity of 82.6%; pfLDH/sLDH ratio has a sensitivity of 86% and specificity of 94.7% and pCHOL with sensitivity of 97.7% and specificity of 100% for differentiating exudative and transudative PE. Conclusion. The determination of pCHOL is of great value for distinguishing between pleural exudates and transudates and should be included in routine laboratory analysis of pleural effusion.

Churg-Strauss syndrome (CSS) is an eosinophil-associated, small vessel granulomatous vaculitis, characterized by late onset asthma, upper airways disease, eosinophilia, and clinical manifestations of systemic vasculitis. [1,[11][12][13] Diagnosis is mainly clinical with findings of asthma, eosinophilia, rhino sinusitis and signs of vasculitis in major organs. So far to the best of our knowledge reporting of CSS has not been done in Nepal. We here present a case of ChurgStrauss syndrome, a Anti-Neutrophil Cytoplasmic Antibody(ANCA) Associated Vasculities more specifically perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) directed against myeloperoxidase (MPO) in a 25years female patient who was initially evaluated for progressive dyspnea, wheeze, cough, joint pain and fever. Regarding the inference drawn from our case report we suggest that patient presenting with the clinical features of asthma needs further evaluation to unmask previously unrecognized underlying Churg-stauss syndrome.

Churg-Strauss syndrome (CSS) is an eosinophil-associated, small vessel granulomatous vaculitis, characterized by late onset asthma, upper airways disease, eosinophilia, and clinical manifestations of systemic vasculitis. [1,11-13] Diagnosis is mainly clinical with findings of asthma, eosinophilia, rhino sinusitis and signs of vasculitis in major organs. So far to the best of our knowledge reporting of CSS has not been done in Nepal. We here present a case of Churg- Strauss syndrome, a Anti-Neutrophil Cytoplasmic Antibody(ANCA) Associated Vasculities more specifically perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) directed against myeloperoxidase (MPO) in a 25years female patient who was initially evaluated for progressive dyspnea, wheeze, cough, joint pain and fever. Regarding the inference drawn from our case report we suggest that patient presenting with the clinical features of asthma needs further evaluation to unmask previously unrecognized underlying Churg-stauss syndrome. DOI: http://dx.doi.org/10.3126/joim.v34i2.9055 Journal of Institute of Medicine August, 2012; 34:2 48-52