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Journal of Gastroenterology

, Volume 33, Issue 1, pp 112–116 | Cite as

Churg-Strauss syndrome (allergic granulomatous angitis) presenting with ileus caused by ischemic ileal ulcer

  • Toshimichi Kaneki
  • Akira Kawashima
  • Toshihide Hayano
  • Takayuki Honda
  • Keishi Kubo
  • Tomonobu Koizumi
  • Morie Sekiguchi
  • Hideyuki Ichikawa
  • Kenji Matsuzawa
  • Tsutomu Katsuyama
Case report

Abstract:

We report a rare case of Churg-Strauss syndrome (CSS) in a 41-year-old Japanese man with a history of middle-age onset of bronchial asthma who had severe abdominal pain. He presented with ileus caused by an annular ulcer of the ileum, attributable to mucosal ischemia resulting from necrotizing vasculitis of the mesenteric artery. He also had marked hypereosinophilia (51.5%), elevated serum IgE levels (34040 IU/ml), and generalized enlargement of the superficial cervical lymph nodes, containing eosinophilic granulomas. A stenotic lesion caused by an annular ulcer in the ileum was found and resected by laparotomy. Microscopic examination of the resected specimen revealed luminal narrowing or occlusion of small arteries in the ulcer base, subserosa, and mesenterium resulting from marked fibrotic intimal thickening with fragmentation or lack of the internal elastic lamina. These findings were diagnosed as vasculitis, scar stage. The postoperative course was uneventful, with the patient receiving a maintenance dose of prednisolone (10–15 mg/day) for 7 years subsequently. We must carefully diagnose and treat patients with middle-age onset asthma, because the symptom may be a lung manifestation of CSS, in which various organs including gastrointestinal tract are involved as a result of systemic necrotizing vasculitis.

Key words: Churg-Strauss syndrome allergic granulomatous angitis ileus intestinal ulcer 

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Copyright information

© Springer-Verlag Tokyo 1998

Authors and Affiliations

  • Toshimichi Kaneki
    • 1
  • Akira Kawashima
    • 1
  • Toshihide Hayano
    • 1
  • Takayuki Honda
    • 3
  • Keishi Kubo
    • 1
  • Tomonobu Koizumi
    • 1
  • Morie Sekiguchi
    • 1
  • Hideyuki Ichikawa
    • 2
  • Kenji Matsuzawa
    • 3
  • Tsutomu Katsuyama
    • 3
  1. 1.First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390, JapanJP
  2. 2.First Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390, JapanJP
  3. 3.Department of Laboratory Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390, JapanJP

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