A limited form of Churg-Strauss syndrome presenting as acute abdominal catastrophe

Abstract

Dear Sir, Allergic granulomatous angiitis (Churg-Strauss syndrome, CSS) is characterized by the triad of asthma, eosinophilia, and systemic vasculitis [1]. In addition to these classical findings, pulmonary infiltrates, skin lesions, eye, gastrointestinal, and lymph node involvement has been reported [5]. There are rare cases of limited form of CSS with no clinical evidence of asthma [6]. The patient presented here had no history of asthma or pulmonary symptoms. The patient's disease was limited to gastrointestinal system and the lymph nodes draining the involved bowel segment.The patient had an elevated white blood cell count (16,800/ml) with normal red cell indices. On peripheral smear eosinophils were significantly elevated (38%). Serological tests for hepatitis B virus and human immunodeficiency virus were negative, as were those for antinuclear antibodies, anti-neutrophil cytoplasmic antibodies (ANCA), and rheumatic factor. Urinalysis showed no proteinuria or hematuria. Renal and liver function tests were within normal limits. IgE levels were normal. The patient's neurological examination and electromyographic findings were normal. Chest computed tomography revealed multiple pulmonary nodules on both lungs. Allergy tests were performed and no allergic response was observed on screening tests.The patient was a 19-year-old man who had experience nausea, diarrhea, and fatigue for 1-2 weeks. The patient presented to the emergency room with abdomi-

Churg–Strauss syndrome manifested by appendicitis, cholecystitis and superficial micronodular liver lesions—an unusual clinicopathological presentation: Figure 1

“…Typically the patients are middle aged, but CSS with abdominal complications has been described in children2 and adolescents 3. The gastrointestinal manifestations include diarrhoea, melena and abdominal cramps 3. Rare cases of intestinal erosion,4 ulceration and perforation3 7 8 have been described.…”

“…The gastrointestinal manifestations include diarrhoea, melena and abdominal cramps 3. Rare cases of intestinal erosion,4 ulceration and perforation3 7 8 have been described. Others include acalculous cholecystitis associated with large liver abscesses,4 liver infarction with cutaneous necrosis,5 and duodenitis 6.…”