SELECTED ARTICLES FROM THE RECENT LITERATURE 2007

August 14, 2007

Warning sign of abdominal pain in asthma

Summary
Background – The occurrence of certain non-respiratory symptoms in a patient with active asthma should raise the diagnostic possibility of superimposed Churg-Strauss Syndrome (CSS).

Findings – Rolla et al of the Univ of Torino in Italy reported a case of a 55 year old man with chronic asthma and rhinosinusitis. The patient had bilateral lower limb parasthesias, cholycystectomy for cholecystitis without gall stones, then severe diffuse abdominal pain. There was prominent blood eosinophilia (1,860 going to 14,000). At laparotomy, findings included a perforated ileum and histologic evidence of necrotizing vasculitis with eosinophilic infiltration of the walls of the ileum. Re-examination of the previously resected gall bladder showed vasculitis and eosinophilic inflammation. A diagnosis of CSS was made and treatment with pulse steroids and cyclophosphamide was followed by clinical improvement.

Reference
Ann Allergy Asthma Immunol 2007;98:595-7

Editor's Comments
Although this was just a case report of a single patient, the clinical picture is fairly similar to other CSS cases seen by me and reported in the literature. Neuropathic symptoms due to mononeuritis multiplex (documented in the patient described above) and complications of vasculitis of the G-I tract occur commonly in the CSS. These symptoms, particularly with prominent eosinophilia occurring in an asthmatic, should raise consideration of a superimposed CSS.

 

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