Churg-strauss syndrome

Is Leukotriene Receptor Antagonist the Direct Cause of Churg-Strauss Syndrome in Asthmatic Patients?

One of the main reasons for continuous, persistent asthma is when there is a change in the structure of the airways and the Lung parenchyma. These persistent changes bring a much worse prognosis to asthmatic conditions and predispose the situation to severe asthmatic syndromes such as Churg-Strauss syndrome (CSS). CSS is an inflammation of systemic blood vessels and is a rare disorder that can be suspected in long-standing asthmatic patients. Leukotriene antagonists receptor antagonists (LTRA) have been used to treat asthma along with tapering steroids. But after the introduction of LTRA therapy in these patients suggests a causal relation between LTRA initiation and the development of CSS, or it is an unmasking of CSS as the dose of steroid tapers down with LTRA therapy. This review highlights the relationship between leukotriene antagonists and the pathogenesis of CSS. It summarizes the current literature regarding the development of CSS with the initiation of LTRA therapy on asthmatic patients. The literature on this topic was reviewed using different research/article searches, manual library searches, conference abstracts, and internet searches.

Eosinophilic granulomatosis with polyangiitis

Eosinophilic granulomatosis with polyangiitis also known as Churg–Strauss syndrome or allergic granulomatosis and angiitis is an extremely rare systemic necrotizing vasculitis that affects small-to-medium-sized vessels. Here, we report a case of a 58-year-old man presenting with painful swelling of bilateral lower limbs with multiple well-defined erosions on lower legs and dorsum of the foot with a few of them showing brownish crusts and with slight watery discharge and a few with raw areas. The patient is a known case of bronchial asthma. Histopathology of foot and face lesion shows inflammatory cell infiltrate predominantly comprising of eosinophils, small- and medium-sized blood vessels are thickened. P-antineutrophil cytoplasmic antibody positivity was seen. Thus, on the basis of positive findings which satisfy the criteria for eosinophilic granulomatosis with polyangiitis, we diagnosed this as a case of eosinophilic granulomatosis with polyangiitis, and for rarity of this case, we would like to report it.

Genetic aspects of adult and pediatric autoimmune hepatitis: A concise review

Autoimmune Hepatitis (AIH) is a heterogenous, mostly chronic liver disease that affects people of all age groups, women more often than men. The aim of therapy is to prevent cirrhosis, as it mainly accounts for liver-related mortality in patients with AIH. Rates of remission are high in patients with AIH, but life-long immunosuppressive therapy is required. AIH is hypothesized to originate from immunologic reactivity targeted against mostly unknown self-antigens, potentially triggered by viral infections among other factors. While AIH does not follow a Mendelian inheritance pattern, part of the risk of developing AIH or worse disease course, is attributed to specific genetic risk factors. Major associations for the risk of development of AIH were found for HLA-DRB1*03:01 and HLA-DRB1*04:01 in adult AIH in the only genome-wide association study on AIH. However, other potential risk loci in SH2B3, CARD10 and KIR genes were described. This review covers the current knowledge on genetic risk factors in adult and pediatric AIH.

Differential Diagnosis of Churg-Strauss Syndrome with Tingling Sensation and Weakness of the Lower Extremities

Introduction

Churg-Strauss syndrome (CSS; or eosinophilic granulomatosis with polyangiitis) is an extremely rare autoimmune condition characterized by hypereosinophilia and vasculitis of small or medium-sized blood vessels, occurring in patients with asthma and allergic rhinitis.

Case Presentation

A 47-year-old man (height, 175.8 cm and weight, 74.8 kg) complained of a tingling sensation in his leg. He had a history of hypertension and asthma in the previous two years, and history of sinus surgery for sinusitis in the previous one year. He showed weight loss of 6 kg during the last month, and the signal intensity of the bone marrow on magnetic resonance imaging was diffusively reduced to be less than or equal to the disc. These findings indicated a hematologic disease and the possibility of malignancy. However, a nerve conduction study suggested multiple mononeuropathies. In addition, his laboratory findings showed peripheral eosinophilia and positivity for myeloperoxidase anti-neutrophil cytoplasmic autoantibody. Therefore, CSS was strongly suspected.

Conclusions

Churg-Strauss syndrome is considered to be a condition with variable presentation and is difficult to diagnose because it has various clinical symptoms and disease progression. This study reports on a case with CSS, who underwent nerve biopsy and cholecystectomy for pathological confirmation because of various symptoms, and early diagnosis was difficult.

Autoimmune Hepatitis in Brazilian Children: IgE and Genetic Polymorphisms in Associated Genes

Pediatric autoimmune hepatitis (AIH) patients present hypergammaglobulinemia, periportal CD8(+) cytotoxic T cell infiltration, and cirrhosis. Autoantibody profile defines AIH types 1 and 2 in addition to strong association with HLA-DRB1. We previously detected increased IgE serum levels and sought to compare clinical and histological features according to IgE levels in AIH (n = 74, ages 1-14 years) patients. Additionally, we typed 117 patients and 227 controls for functional polymorphisms of IL4, IL13, IL5, and IL4RA genes involved in IgE switching and eosinophil maturation that might contribute to overall genetic susceptibility to AIH. Serum IgE levels were high in 55% of AIH-1, but only in 12% of AIH-2 (P = 0.003) patients. Liver IgE was present in 91.3% of AIH-1 patients. The A alleles at both IL13 rs20541 and IL4RA rs1805011 were associated with AIH-1 (P = 0.024, OR = 1.55 and P < 0.0001, OR = 2.15, resp.). Furthermore, individuals presenting homozygosis for the A allele at IL4RA rs1805011 and HLA-DRB1(∗)03 and/or (∗)13 allele had sixfold greater risk to develop the disease (OR = 14.00, P < 0.001). The novel association suggests an additional role for IgE-linked immune response genes in the pathogenesis of AIH.

"Peripheral neuropathy crippling bronchial asthma": two rare case reports of churg-strauss syndrome

Churg-Strauss syndrome (CSS) is a rare cause of vasculitic neuropathy. Although rare and potentially fatal, Churg-Strauss syndrome (CSS) is easily diagnosable and treatable. The presence of bronchial asthma with peripheral neuropathy in a patient alerts a physician to this diagnosis. This is vividly illustrated by the presented two cases who had neuropathy associated with bronchial asthma, eosinophilia, sinusitis, and positive perinuclear antineutrophil cytoplasmic antibodies (p-ANCA) test, which improved with administration of steroids.

Clinical study of renal impairment in patients with propylthiouracil-induced small-vessel vasculitis and patients with primary ANCA-associated small-vessel vasculitis

The aim of this study was to compare renal impairment in patients with propylthiouracil (PTU)-induced small-vessel vasculitis and patients with primary anti-neutrophil cytoplasmic antibody (ANCA)-induced small-vessel vasculitis. The study compared the pathology and clinical conditions of 10 patients with PTU-associated small-vessel vasculitis and 18 patients with primary ANCA-associated small-vessel vasculitis. All patients showed manifestations of renal impairment. Compared with the primary ANCA-induced small-vessel vasculitis, patients with PTU-induced small-vessel vasculitis were mostly female (P<0.05) and deleloped the disease at a younger age (P<0.05). They had a higher positive rate of perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA; P<0.05), lower 24 h proteinuria content, lower serum creatinine (P<0.05) and milder histopathological lesions (P<0.05). A number of them had gross hematuria (P<0.05). They rarely used hormone and cytotoxic drugs (P<0.05) during treatment and had a better prognosis (P<0.05). In conclusion, PTU-induced small-vessel vasculitis has a milder pathology and clinical manifestations with a better prognosis.