ChurgStrauss syndrome with peripheral gangrene and severe renal failure

A 32-year-old man, known asthmatic since childhood, presented with multiple ulcers over lower legs, burning sensation over fingers and blackish discoloration of left little finger. On examination, he had systemic hypertension, tenderness over maxillary sinuses, left-sided foot drop and gangrene of left little finger. The investigations showed anemia, eosinophilia, elevated serum immunoglobulin E level, elevated myeloperoxidase level, proteinuria and raised creatinine. A diagnosis of Churg-Strauss syndrome with rare manifestations of gangrene and severe renal failure was made with the above features.