A patient with Churg-Strauss syndrome who underwent left below-the-knee amputation as a result of involvement of the left superficial femoral artery

,A 33 year old Korean male was diagnosed with bronchial asthma ten months previously and this was being managed at the pulmonary clinic. Four months prior, he had complaints of purpuric skin lesions on the lower extremities and the gradual onset of coldness, discoloration and desquamation of his finger tips. These signs and symptoms, including his skin lesions, improved with 4 weeks of oral steroid treatment. However, after withdrawal of the steroids, there was subsequent development of exertional claudication of his lower extremities and tingling and coldness of his left foot. His laboratory data was significant for leukocytosis with peripheral eosinophilia. Angiography revealed complete occlusion of his left distal femoral artery. The patient was treated by performing interventional thrombolysis with tissue plasminogen activator (t-PA) and heparinization, but the follow up angiography showed failure of this treatment. His left lower extremity became gangrenous and was subsequently amputated, despite the daily treatment with oral prednisolone 30 mg and cyclophosphamide 75 mg. As shown in this case, a relatively large vessel occlusion could be an early manifestation of Churg-Strauss syndrome, and physicians need to be cognizant that it can present in an atypical fashion.(Korean J Med 72:S338-S344, 2007)