Churg Strauss Syndrome with Migratory Polyarthritis

Mayo Clinic Proceedings, 2010

A 52-year-old previously healthy man was admitted to an inpatient internal medicine resident hospital service with a 2-week history of profound generalized fatigue, nocturnal fevers (temperature as high as 39.4˚C [103˚F]), cold sweats, anorexia, and bilateral hand swelling and numbness. The swelling progressed to symmetrically involve his elbows, shoulders, knees, and ankles. He also reported arthralgias and profound weakness that had caused him to be confined to a wheelchair. He experienced joint stiffness of less than 30 minutes' duration in the morning that improved with activity. He denied recent tick bites, exposures to sick contacts, or travel outside of Minnesota and reported no recent weight loss, sore throat, or infection. A full review of systems was otherwise unremarkable. Family history was remarkable for an aunt and cousin with lupus.

The Korean Journal of Internal Medicine, 2015

Clinical Nephrology, 2009

because of generalized range, 5-26), alanine aminotransferase 10 U/l (normal fatigue, nausea, and vomiting. One month after birth, range, 1-23). Blood urea nitrogen (BUN) was he was diagnosed with Down's syndrome. At 5 years 84 mg/dl, serum creatinine was 8.0 mg/dl, and uric of age, he was diagnosed with Fallot's tetralogy, and acid was 10.9 mg/dl. Sodium was 135 mEq/l, potassium he underwent surgery for an endocardial cushion defect was 6.7 mEq/l, chloride was 108 mEq/l, Ca was in our hospital at 7 years of age. In August 1996, he 7.7 mg/dl, and inorganic P was 6.8 mg/dl. Total visited a neighbourhood doctor because of fever and protein was 6.1 g/dl, albumin was 2.8 g/dl, IgG was appetite loss after dental care in July, and he was 5211 mg/dl, IgA was 380 mg/dl, and IgM was referred to our hospital on 4 September. Laboratory 219 mg/dl. ASO was 154 Todd units. C-reactive protein data revealed that WBC was 9000/ml, haemoglobin was 7.6 mg/dl (normal range, 0-0.5). Rheumatoid was 9.7 g/dl, platelets were 112 000/ml, BUN was factor was 80 IU/ml (normal range, below 10). 25 mg/dl, creatinine was 2.3 mg/dl, uric acid was Tests for hepatitis B antigen, hepatitis C antibody, 6.3 mg/dl, and CRP was 8.4 mg/dl. Urinalysis showed cryoglobulin and antinuclear antibody were negative. urinary protein was 2+ for dipstick, and occult blood Anti-DNA,-RNP,-Sm,-SS-A, and-SS-B antibodies were negative. Complement C3 was 23 mg/dl (normal Correspondence and offprint requests to: Hirokazu Imai MD, Third range, 60-116), C4 was 5 mg/dl (normal range, 15-44),

Arthritis & Rheumatism, 2005

Objective. Churg-Strauss syndrome (CSS) is classified among the so-called antineutrophil cytoplasmic antibody-associated systemic vasculitides (AASVs) because of its clinicopathologic features that overlap with the other AASVs. However, while antineutrophil cytoplasmic antibodies (ANCAs) are consistently found in 75-95% of patients with Wegener's granulomatosis or microscopic polyangiitis, their prevalence in CSS varies widely and their clinical significance remains uncertain. We undertook this study to examine the prevalence and antigen specificity of ANCAs in a large cohort of patients with CSS. Moreover, we evaluated the relationship between ANCA positivity and clinicopathologic features.

JDDG: Journal der Deutschen Dermatologischen Gesellschaft

Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology

HSS Journal, 2012

An 85-year-old Chinese woman with a 4-year history of asthma presented with a severe headache for 1 week and substernal chest pain for 1 day. Seven days prior to presentation, the patient was seen by her primary care physician for evaluation of a new-onset severe headache; she was prescribed an unknown dose of ibuprofen, which she took for 2 days before developing facial swelling and hives. The facial swelling and rash resolved shortly after discontinuing ibuprofen, but the headache continued. Two days prior to presentation, the patient went to the emergency room because of her headache; a non-contrast head computed tomography (CT) scan was negative and she was discharged without further workup. Two days later, the patient developed substernal chest pain. She returned to the emergency room and was admitted for further evaluation. On admission, the patient reported frontal and temporal headache without nausea or photosensitivity. She also complained of gradually intensifying, substernal, nonpleuritic chest pain that did not radiate and was not associated with cough or shortness of breath. She denied fever, chills, changes in weight, rash, alopecia, visual disturbance, oral or nasal ulcers, sinus pain, hemoptysis, abdominal pain, nausea, vomiting, diarrhea, dysuria, hematuria, joint pain, or focal weakness. She reported intermittent episodes of dry cough and shortness of breath over the past 4 years that had been diagnosed and treated as asthma. Past medical history was significant for pulmonary tuberculosis, diagnosed and treated with an unknown medication regimen in 1968. Despite this treatment, she developed disseminated tuberculosis of the thoracic and pelvic lymph nodes, liver, and spine in 1990. She required spine surgery at that time and was treated with an unknown multidrug regimen for the next 4 years. Her other medical history included asthma, hyperlipidemia, and gastroesophageal reflux disease. She had undergone a meningioma resection in the late 1980s. Medications on admission included metoprolol 50 mg daily, aspirin 81 mg daily, simvastatin 20 mg daily, fluticasone/salmeterol 250 mcg inhaled twice daily, gabapentin 300 mg three times daily, pantoprazole 20 mg daily, trazadone 25 mg nightly, and zolpidem 5 mg nightly. There were no known drug allergies. The patient was born in China and moved to the USA in 1968. She had last traveled back to China in 1990. She lived alone but had family nearby. She did not use tobacco, alcohol, or illicit drugs. She had no family history of autoimmune disease.

Journal of the American Academy of Dermatology, 1992

Advances in the Diagnosis and Treatment of Vasculitis, 2011

Yeungnam University Journal of Medicine, 2015

Churg-Strauss syndrome (CSS) is a necrotizing vasculitis with extra-, peri-vascular eosinophilic infiltration. Chronic symmetric polyarthritis with the presence of rheumatoid factor (RF) and anti-cyclic citrullinated peptide antibody are the mainstay of rheumatoid arthritis (RA) diagnosis. Mononeuritis multiplex is a peripheral neuropathy involving more than 2 separate nerve areas. A 62-year-old male patient was referred for left foot drop and polyarthritis of both hands and feet for 4 months. During evaluation, mononeuritis multiplex was detected on nerve conduction study and electromyography tests: vasculitis with neutrophil, eosinophil, and lymphocyte infiltration on peroneal nerve biopsy. A positive response to methacholin and bronchodilator was observed on the pulmonary function test. Radiologic tests showed peri-articular soft tissue swelling and osteopenia on both hand and foot. Marked peripheral eosinophilia, high RF, and positive perinuclear anti-neutrophil cytoplasmic antibody were detected on blood tests. Here, we report on a patient with overlap syndrome of CSS and RA with review of the relevant literature, from which a few references to overlap syndrome of CSS and RA were available.