Churg-Strauss syndrome

Churg-Strauss syndrome (CSS) is characterized by asthma, eosinophilia and systemic small and medium-sized vasculitis. In a 27-year old woman with a history of asthma suffering from fever, joint pain, weight loss, dyspnea, cough and mild hemoptysis we diagnosed pulmonary infiltrates (X-ray film of chest) and paranasal sinus abnormalities and heart failure. Symp- toms appeared after oral glycocorticosteroid withdrawal and after inhaled glycocorticosteroid dose decrease during antileukotriene drug (montelukast) therapy. Echocardiogram showed generalized left ventricle hypokinesis, decreased ejection fraction (EF) of 37% and pericardial effusion without signs of tamponade. We observed eosinophilia (42%), increased serum C-reactive protein and IgE concentration in the patient. There were no ANCA. We diagnosed CSS with heart involvement. We treated the patient with glucocorticosteroids and immunosuppressant (azathioprine). Heart failure was treated with ACEI (perindopril), diu- retics (furosemide, spironolactone) and digoxin. After 3 years from the beginning of the dis- ease, the patient is still in class II of heart failure according to NYHA classification but there are more marked signs of left ventricular dysfunction in the echocardiogram and EF is still decreased (about 30%). (Folia Cardiol. 2005; 12: 394-402) Churg-Strauss syndrome, eosinophilia, systemic vasculitis, heart failure