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Sir -We present the case of a 54-year old woman, initially diagnosed with Churg-Strauss syndrome (CSS) in May 1995 following admission with severe constitutional symptoms comprising pyrexia, fatigue and myalgia. Additionally, she had sinusitis, dyspnoea, acute haemoptysis, and chest pain of approximately one-week duration. She had a 27-year history of atopia and 'extrinsic' asthma, requiring corticosteroid treatment from two years to eight weeks prior to admission. Examination revealed vasculitic skin lesions over the limb extremities, and subsequent biopsy showed leucocytoclastic vasculitis with eosinophil infiltrates. Full blood count (FBC) revealed eosinophilia of 5.15 Â 10 9 /L (35% total white cell count) and pulmonary infiltrates were noted on CXR. A transthoracic echocardiogram showed moderate left ventricular dysfunction with anterior infarct, and moderate mitral and tricuspid valve regurgitation. There was no evidence of cardiac thrombus. Autoantibodies including ANCA, ANA and ENA were negative. The patient was successfully treated with pulse methylprednisolone followed by oral prednisolone. Coronary angiography performed in August 1995 showed normal coronary arteries.
Sir -We present the case of a 54-year old woman, initially diagnosed with Churg-Strauss syndrome (CSS) in May 1995 following admission with severe constitutional symptoms comprising pyrexia, fatigue and myalgia. Additionally, she had sinusitis, dyspnoea, acute haemoptysis, and chest pain of approximately one-week duration. She had a 27-year history of atopia and 'extrinsic' asthma, requiring corticosteroid treatment from two years to eight weeks prior to admission. Examination revealed vasculitic skin lesions over the limb extremities, and subsequent biopsy showed leucocytoclastic vasculitis with eosinophil infiltrates. Full blood count (FBC) revealed eosinophilia of 5.15 Â 10 9 /L (35% total white cell count) and pulmonary infiltrates were noted on CXR. A transthoracic echocardiogram showed moderate left ventricular dysfunction with anterior infarct, and moderate mitral and tricuspid valve regurgitation. There was no evidence of cardiac thrombus. Autoantibodies including ANCA, ANA and ENA were negative. The patient was successfully treated with pulse methylprednisolone followed by oral prednisolone. Coronary angiography performed in August 1995 showed normal coronary arteries.
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