scholarly journals Multiple strokes and cerebral microangiopathy in a patient with Churg-Strauss syndrome

2021 ◽  
Author(s):  
Vitalie Văcăraș ◽  
Roxana-Maria Radu ◽  
Enia Cucu ◽  
Dafin Fior Mureșanu
Keyword(s):  
Chronic Renal Disease ◽  
Eosinophilic Granulomatosis With Polyangiitis ◽  
Vein Thrombosis ◽  
Multisystemic Disease ◽  
Strauss Syndrome ◽  
Cerebral Microangiopathy ◽  
Deep Vein ◽  
Disease Grade ◽  
Eosinophilic Granulomatosis ◽  
Churg Strauss

Eosinophilic granulomatosis with polyangiitis (EGPA) is a multisystemic disease that mainly affects the lungs and skin. It is considered to be a small and medium-vessel vasculitis. Although neurologic manifestations of EGPA are reported, usually consisting of peripheral neuropathy, central nervous system manifestations are quite rare, those described being cerebral infarctions or hemorrhages.  We present the case of a 79-year-old woman diagnosed in 2016 with EGPA, being treated with Prednisone and Azathioprine, who presented to the Neurological Emergency Department with right hemiplegia, dysmetria in the left arm and right hemi-hypoesthesia. CT (computed tomography) and MRI (Magnetic resonance imaging) findings on admission described lacunar strokes. The patient presented with low creatinine clearance on admission (positive for chronic renal disease), grade III hypertension, ischemic cardiomyopathy and right calf deep vein thrombosis. The patient was started on neuroprotective and neurotrophic treatment associated with parenteral hydration, anticoagulant and hypotensive drugs .  The patient’s symptoms partially improved, with possibility of independently maintaining a sitting position and upright stance with unilateral sustenance at discharge. Patients suffering from vasculitides must be carefully observed in order to prevent or treat complications that may emerge.

scholarly journals Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)

2020 ◽  
Vol 66 (7) ◽  
pp. 904-907
Author(s):  
Gabriela Venade ◽  
Cátia Figueiredo ◽  
Catarina Almeida ◽  
Nídia Oliveira ◽  
Luis Costa Matos
Keyword(s):  
Complex Disease ◽  
Granulomatosis With Polyangiitis ◽  
Previous History ◽  
Specific Treatment ◽  
Disease Diagnosis ◽  
Eosinophilic Granulomatosis With Polyangiitis ◽  
Churg Strauss Syndrome ◽  
Strauss Syndrome ◽  
Eosinophilic Granulomatosis ◽  
Churg Strauss

SUMMARY Churg–Strauss syndrome, Eosinophilic granulomatosis with polyangiitis (EGPA), is a systemic vasculitis that affects small– to medium-sized vessels. It is rare and part of the Anti-neutrophil cytoplasm antibody-associated vasculitis (ANCA) group. We present a 37-year-old man, with a previous history of asthma, that was sent to the ED due to 2 weeks of productive cough, occasional dyspnea on exertion, fever (one week), asthenia, and anorexia. Upon physical examination, he was subfebrile and tachycardic. He had leukocytosis (17.00 x10^9/L) and eosinophilia of 20.0 % (3.4 X10^9/L), creatinine level of 1.5 mg/dL, subtle elevation on liver function tests and CRP of 10.82mg/dL. On Chest X-Ray, there was infiltrate on the right pulmonary base. Due to a strong suspicion of EGPA, he was started on 80mg of prednisolone from admission. ANCA MPO was positive, with the remaining auto-immune study negative. He underwent Thorax CT (under corticotherapy) without relevant changes, as well as bronchoalveolar lavage, without macroscopic signs of alveolar hemorrhage. Because of active urinary sediment, nephrotic proteinuria (6.5g/24h), and acute renal failure he underwent a renal biopsy, which revealed pauci-immune crescentic glomerulonephritis, with predominantly acute findings (in the context of ANCA-MPO Vasculitis – EGPA). After the biopsy, he received three 1g methylprednisolone pulses and was started on Cyclophosphamide. He remained asymptomatic and renal function was restored. This case highlights the importance of integrating all findings in one clinical scenario to prevent a more complex disease diagnosis, with a specific treatment, from being missed.

Childhood-onset Eosinophilic Granulomatosis with Polyangiitis (formerly Churg-Strauss Syndrome): A Contemporary Single-center Cohort

2013 ◽  
Vol 40 (6) ◽  
pp. 929-935 ◽  
Author(s):  
Samantha Gendelman ◽  
Andrew Zeft ◽  
Steven J. Spalding
Keyword(s):  
Granulomatosis With Polyangiitis ◽  
Upper Airway ◽  
Initial Therapy ◽  
Eosinophilic Granulomatosis With Polyangiitis ◽  
Childhood Onset ◽  
Churg Strauss Syndrome ◽  
Organ Systems ◽  
Strauss Syndrome ◽  
Eosinophilic Granulomatosis ◽  
Churg Strauss

Objective.To date only 38 cases of childhood-onset eosinophilic granulomatosis with polyangiitis (cEGPA; formerly Churg-Strauss syndrome) have been reported. Additional patients with cEGPA could enhance the understanding of this rare and life-threatening condition. Our objectives were (1) to determine the frequency of specific organ system involvement; (2) to examine initial therapeutic regimen; and (3) to document disease and therapy-related morbidity in a contemporary cohort of patients with cEGPA.Methods.Retrospective review of patients evaluated at the Cleveland Clinic between 2003 and 2011 who met either American College of Rheumatology or Lanham criteria for EGPA and whose age was < 18 years at symptom onset.Results.Nine patients (8 female; 7 white) were identified. Median age at onset of rhinitis/asthma symptom was 13 years and median age at diagnosis of cEGPA was 15 years. All patients demonstrated eosinophilia, upper airway disease (allergic rhinitis, chronic sinusitis, and/or nasal polyps), and pulmonary involvement. Other frequently involved organ systems included musculoskeletal (67%), gastrointestinal (67%), cutaneous (67%), neurologic (56%), and cardiac (44%). Antineutrophil cytoplasmic antibody (ANCA) serologies were negative in all patients. The medications used most frequently for initial therapy included oral (44%) or intravenous corticosteroids (56%) and azathioprine (67%). Disease or therapeutic complications occurred in half of the cohort and included heart failure, stroke, and sequela from longterm, high-dose steroids.Conclusion.Eosinophilia, in combination with upper airway, pulmonary, musculoskeletal, neurologic, and cardiac manifestations, is frequently observed in cEGPA. ANCA titers are often negative. Steroids are the mainstay of initial therapy but steroid-related side effects occur regularly.

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