Allergy Asthma Respir Dis.  2013 Jun;1(2):164-167. 10.4168/aard.2013.1.2.164.

A case of churg-strauss syndrome: evidence of eosinophilic vasculitis on liver biopsy

• Kim HS
• Jeong HK
• Kim DH
• Yu J
• Kim Y
• Koh YI

• KMID: 2261865
• DOI: http://doi.org/10.4168/aard.2013.1.2.164

Abstract

PURPOSE
Churg-Strauss syndrome (CSS) is a rare disease characterized by pulmonary and systemic small vessel necrotizing vasculitis and peripheral blood eosinophilia occurring in asthmatics. Cases of CSS with hepatic involvement have been rarely reported. Here, we reported a case of CSS involving liver, in which liver biopsy revealed eosinophilic vasculitis.
METHODS
A 75-year-old man complained of dyspnea and hemoptysis. He had severe blood eosinophilia (white blood cell 28,320/microL, eosinophils 79%). Computed tomography of chest and abdomen showed infiltrations in lungs and multifocal infiltrations in both hepatic lobes. Methacholine PC20 was 2.89 mg/mL, which was in asthmatic range.
RESULTS
Ultrasonography-guided liver biopsy was performed, showing eosinophilic vasculitis and portal granulomas. CSS can be diagnosed based on evidence of asthma, blood eosinophilia, pulmonary infiltration and vasculitis on biopsy.
CONCLUSION
Taken together, in a suspected case of CSS presenting as hepatic involvement, liver biopsy may be useful to demonstrate the presence of vasculitis.

Keyword

Churg-Strauss syndrome; Liver; Biopsy; Vasculitis

MeSH Terms

Abdomen
Asthma
Biopsy
Blood Cells
Churg-Strauss Syndrome
Dyspnea
Eosinophilia
Eosinophils
Glycosaminoglycans
Granuloma
Hemoptysis
Liver
Lung
Methacholine Chloride
Pulmonary Eosinophilia
Rare Diseases
Thorax
Vasculitis
Glycosaminoglycans
Methacholine Chloride

Figure

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  Fig. 1 Chest computed tomography shows multiple small nodules with surrounding ground grass opacities (A) and pericardial effusion (B).

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  Fig. 2 Abdomen computed tomography shows multiple low attenuated lesions at both hepatic lobes.

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  Fig. 3 Liver biopsy shows diffuse eosinophilic infiltration (A) and eosinophilic vasculitis (B, arrows) (H&E, ×200).

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