Ann Rehabil Med.  2015 Jun;39(3):477-481. 10.5535/arm.2015.39.3.477.

Churg-Strauss Syndrome as an Unusual Cause of Dysphagia: Case Report

• Park J
• Im S
• Moon SJ
• Park GY
• Jang Y
• Kim Y

• KMID: 2165652
• DOI: http://doi.org/10.5535/arm.2015.39.3.477

Abstract

Systemic vasculitis is a rare disease, and the diagnosis is very difficult when patient shows atypical symptoms. We experienced an unusual case of dysphagia caused by Churg-Strauss syndrome with lower cranial nerve involvement. A 74-year-old man, with a past history of sinusitis, asthma, and hearing deficiency, was admitted to our department for evaluation of dysphagia. He also complained of recurrent bleeding of nasal cavities and esophagus. Brain magnetic resonance imaging did not show definite abnormality, and electrophysiologic findings were suggestive of mononeuritis multiplex. Dysphagia had not improved after conventional therapy. Biopsy of the nasal cavity showed extravascular eosinophilic infiltration. All these findings suggested a rare form of Churg-Strauss syndrome involving multiple lower cranial nerves. Dysphagia improved after steroid therapy.

Keyword

Churg-Strauss syndrome; Deglutition disorders; Cranial nerve diseases

MeSH Terms

Aged
Asthma
Biopsy
Brain
Churg-Strauss Syndrome*
Cranial Nerve Diseases
Cranial Nerves
Deglutition Disorders*
Diagnosis
Eosinophils
Esophagus
Hearing
Hemorrhage
Humans
Magnetic Resonance Imaging
Mononeuropathies
Nasal Cavity
Rare Diseases
Sinusitis
Systemic Vasculitis

Figure

• 

  Fig. 1 Endoscopic findings show multiple esophageal ulcers with bleeding.

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  Fig. 2 Results of magnetic resonance imaging (MRI) and computed tomography (CT). T2-weighted brain MRI (A, B) in the axial view show no acute lesion or neurodegenerative change. Chest CT (C) in the axial view showed small centrilobular nodules in right upper lobe posterior segment and multifocal bronchiolitis in bilateral upper and lower lobes. Paranasal sinus CT (D) in coronal section showed mucosal thickening (asterisks) in bilateral maxillary sinuses.

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  Fig. 3 Results of videofluoroscopic swallowing study (VFSS) and fiberoptic endoscopic evaluation of swallowing (FEES). (A) VFSS show gross silent aspiration with plain liquid. Vallecular and pyriform sinuses residues were observed. (B) FEES show a large amount of secretion in the laryngeal vestibules (A, arytenoid; PS, pyriform sinus; E, epiglottis; T, L-tube).

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  Fig. 4 Biopsy findings. Nasal biopsy (A) and esophageal biopsy (B) show extravascular eosinophilic infiltration (H&E, ×400).

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