Churg-Strauss syndrome with perforating ulcers of the colon

Abstract

We report a case of a 72-year-old woman with Churg-Strauss syndrome, who presented with intestinal perforation. She has had bronchial asthma with peripheral blood eosinophilia for 30 years. Gross findings of a resected colon showed multiple ulcers with perforation. Histologic findings demonstrated transmural inflammation infiltrated with large numbers of eosionophils, neutrophils and lymphoplasma cells, and characteristic extravascular granuloma in the subserosa. There were multifocally-distributed transmural vasculitis showing all stages of activity in medium and small-sized arteries and veins located in the submucosa, and proper muscle and subserosal layers of the colon, some of which revealed granulomatous inflammation. Histologic finding of liver showed chronic viral hepatitis B with mild inflammatory activity and macronodular cirrhosis. Immunohistochemical findings, acid fuschin orange G staining and electromicroscope found no evidence of hepatitis B virus infection contributing to the pathogenesis of this lesion.

Bowel perforations in a patient affected by Churg–Strauss syndrome under high-dose steroid treatment: will alternative drugs reduce risk of surgery?

“…Small bowel appears to be more frequently involved (Table 1) [4][5][6]. Clinical manifestations of bowel localization usually consist on abdominal pain and gastrointestinal disorders [7].…”

Eosinophilic Granulomatosis with Polyangiitis and Diffuse Gastrointestinal Involvement

“…Of all the systemic manifestations, GI involvement has a negative prognostic factor, especially if mesenteric infarction and bowel perforation are present [ 7 ]. GI involvement has been reported to occur in approximately 50% of patients with a diagnosis of EGPA, symptoms including abdominal pain, vomiting and diarrhea [ 8 ]. For few cases the actual pathology has been described as it is difficult to document.…”

“…Ischemic changes in the GI tract are rarely documented as the GI tract has a robust collateral blood supply reducing the incidence of ischemia. Histologic vasculitis is rarely seen on biopsy sections as endoscopic biopsies are too superficial to adequately sample submucosal vessels [ 8 ].…”

Churg-Strauss Syndrome and Active Chronic Hepatitis B Virus Infection: Coincidence or Association?

“…To date, there has been only one case report of a patient who harbored a natural HBV infection and suffered from CSS that affected the colon 9. However, that report did not investigate whether the HBV infection triggered the onset of CSS.…”