Churg-Strauss syndrome (allergic granulomatous antiitis) with multiple perforating ulcers of the small intestine, multiple ulcers of the colon, and mononeuritis multiplex
- 70 Downloads
A case of Churg-Strauss syndrome with multiple perforations of the small intestine is described. A 31-year-old woman was admitted with a complaint of epigastric pain. She had a history of bronchial asthma. One week before admission, white blood cell count was 20 800/mm3 with 59% eosinophils. Neurological examination on admission disclosed mononeuritis multiplex with paresthesia in both the lower and upper extremities. At colonoscopy, there were scattered aphthous ulcers in the colon. Ophthalmological examination revealed allergic conjunctivitis. After admission, hypereosinophilia increased to as high as 36 000/mm3. Oral administration of prednisolone (60 mg/day) was begun. On the 3rd day of the treatment, the eosinophil count decreased dramatically, to 400/mm3, while severe abdominal pain developed. Since abdominal X-ray film revealed free air in the abdominal cavity, emergency laparotomy was performed and multiple intestinal ulcers with perforations were found. Partial ileectomy was performed. Pathological findings of the resected specimen were interpreted as a necrotizing angiitis with extravascular granuloma. Since the operation, the patient has been asymptomatic, except for neurological symptoms. Hypereosinophilia has decreased without treatment to counts averaging 270/mm3, within 3 months. On the basis of the clinical features and histopathological findings, a diagnosis of Churg-Strauss syndrome was established.
Key wordsChurg-Strauss syndrome allergic granulomatous angiitis perforation multiple ulcers eosinophilia
Unable to display preview. Download preview PDF.
- 1.Churg J, Strauss L. Allergic granulomatosis and granulomatous-vascular syndromes. Ann Allergy 1951;27:277–301.Google Scholar
- 7.Camilleri M, Pusey CD, Chadwick VS, Rees AJ. Gastrointestinal manifestations of systemic vasculitis. Q J Med 1983; 206:141–149.Google Scholar
- 12.Hartley RV, Harris A, Atkinson M. Treatment of a patient with clinical features of both eosinophilic gastroenteritis and polyarteritis nodosa with oral sodium cromoglycate. Dig Dis Sci 1980;25:470–477.Google Scholar
- 14.Felt-Bersman RJF, Meuwissen SGM, van Velzen D. Perforation of the small intestine due to eosinophilic gastroenteritis. Am J Gastroenterol 1984;79:442–445.Google Scholar
- 15.Wallia HS, Abraham TK, Wallia HK. Eosinophilic enteritis with perforation. Can J Surg 1988;31:268–269.Google Scholar
- 16.Shields CL, Shields JA, Rozanski TI. Conjunctival involvement in Churg-Strauss syndrome. Am J Opthalmol 1986;102: 601–605.Google Scholar