Churg-Strauss Syndrome Presented With Abdominal Pain And Foot Drop
Dr. Mushtak Talib Abbas (MD) (MRCP) Senior Specialist/ Department of Medicine Hamad general Hospital/Doha-Qatar
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Abdominal complications are occasionally reported in the Churg-Strauss syndrome (CSS), cholecystitis, pancreatitis, and diffuse vasculitis. We report a case of a patient with CSS, with all these complications. A 33 year old man with an eight year history of asthma and recurrent sinusitis was admitted for abdominal pain. Later on, a vasculitic skin rash developed on the left foot drop.. An increasing peripheral oeosinophilia rising from 25% to 49% in the past month was detected. His pancreatic and liver enzymes increased, and abdominal ultrasonagraphy performed, disclosed a partially distended thick-walled gall bladder with diagnosis of acalculous cholecystitis. Computed tomography (CT) scan of his abdomen showed normal thickness of the bowel wall with oedema in the mesentery, suggestive of an inflammatory process, with patent major mesenteric vessels. Upper endoscopy done, showed diffuse gastritis with multiple mucosal petechiae and positive perinuclear antineutropil cytoplasmic antibody (p-ANCA) of 164 IU/Ml. Nerve conduction study showed severe prominent axonal damage of the sural and tibial nerves in the left leg, and normal peroneal nerve parameters, suggestive of Mononeuritis multiple. The diagnosis of Churg-strauss syndrome was made, with small vessel abdominal vasculitic process.Intravenous pulse methylprednisolone 250 mg/day for three days was given, and a pulse dose of cyclophosphamide was given. His condition showed dramatic improvement and was discharged on oral steroids.