Mialgias y eosinofilia periférica: presentaciÓn atípica del síndrome de Churg-Strauss

Churg-Strauss Syndrome is a small-vessels systemic necrotizing vasculitis with extravascular granulomas and hypereosinophilia. The diagnosis must be suspected in patients with bronchial asthma, pulmonary infiltrates, hypereosinophilia and a clinical picture of vasculitis. Respiratory involvement is the most common but evidences of vasculitis may be present in many other sites affecting peripheral nervous system, heart, skin, kidneys and the gastrointestinal tract. Muscular involvement is uncommon as initial manifestation of the disease. We present a 57 years old man with bronchial asthma and peripheral eosinophilia diagnosed four years before admission treated with inhalatory steroids. He was admitted to the hospital because he complains myalgias on the last month without response to non-steroid antinflammatory drugs. The pain was intense and required opiates analgesics. The physical examination showed myalgias and muscle weakness and hypotrophy in the arms and the legs with proximal distribution. Laboratory values showed peripheral hypereosinophilia (10.000/mm 3 ), CPK and Aldolase elevation. Parasitosis was ruled out by serologic and parasitologic tests. The electromiographic record showed no evidence of peripheral nervous system . Bone marrow aspiration and biopsy ruled out oncohematologic disease. Muscle biopsy specimen was informed with focal eosinophilic vasculitis and perivasculitis without granulomas. Methylprednisone 40 mg/day was instituted with clinical remission and rapid diminution of the eosinophil count and the levels of muscular enzymes. P-ANCA was positive and C-ANCA was negative. This case showed an infrequent and atypical clinical presentation of the Churg-Strauss Syndrome and this entity must be considered in the differential diagnosis of patients with the eosinophilia-myalgia syndrome.