CHURG-STRAUSS-SYNDROME

A 41-year-old woman was hospitalized because of dyspnoea, myalgia-like aches in the shoulders and back, recurrent fever up to 38 degrees C and a feeling of beeing in poor health for some 6 weeks. She had allergic rhinitis and, for the past 3 years, bronchial asthma. One year ago maxillary sinusitis had been diagnosed. The blood sedimentation rate was increased and there was marked eosinophilia (74% eosinophils in the differential blood count). The titres of antibodies against cytoplasmatic components of neutrophil granulocytes (pANCA and cANCA) were negative. The chest radiograph showed marked pleuropulmonary shadows. Pulmonary aspergillosis, Wegener granulomatosis, panarteritis nodosa and hypereosinophilic leukaemia were excluded on clinical and biochemical grounds, as well as by bone-marrow biopsy. Transbronchially obtained lung tissue histolgically demonstrated interstitial and intra-alveolar infiltration with eosinophilic granulocytes and comfirmed the clinically suspected diagnosis of Churg-Strauss syndrome. Under treatment with prednisone, 100 mg daily, the symptoms improved within a few days and the chest radiograph became normal within 14 days. 15 months later the patient, now on prednisone by mouth, 5 mg daily, was free of symptoms.