Churg-Strauss syndrome in two patients receiving montelukast.
OBJECTIVE
Churg-Strauss syndrome (CSS) has been described in association with the treatment of asthmatic patients with leukotriene receptor antagonist. The main mechanism proposed to explain this condition is the unmasking of CSS after the leukotriene receptor antagonist has allowed corticosteroid tapering. Other hypotheses might be proposed.


METHODS
We describe two patients who developed CSS after starting treatment with montelukast, a new antileukotriene drug.


RESULTS
Both patients presented with CSS after 4-5 months of treatment with montelukast. Neither patient received long-term systemic steroids for asthma, but both were on inhaled steroids. One patient had a myocardial involvement and experienced a stroke. Our two patients were treated with systemic steroids and cyclophosphamide.


CONCLUSIONS
CSS does not appear to relate to steroid tapering in our patients. The other hypotheses are a coincidence or a direct adverse effect of the antileukotriene. Long-term data on these drugs are lacking and leukotriene's role in vasculitis remains to be elucidated.
Guilpain
P
P
Department of Internal Medicine, Hôpital Avicenne, Assistance Publique, Hôpitaux de Paris, Université Paris-Nord UPRES EA 3409, 125 route de Stalingrad, 93009 Bobigny Cedex, France.
Viallard
J-F
JF
Lagarde
P
P
Cohen
P
P
Kambouchner
M
M
Pellegrin
J-L
JL
Guillevin
L
L
D000085:Acetates / Q000627:therapeutic use*; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000150:complications* / Q000188:drug therapy; D015267:Churg-Strauss Syndrome / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D003520:Cyclophosphamide / Q000627:therapeutic use; D003521:Cyclopropanes; D004359:Drug Therapy, Combination; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D020024:Leukotriene Antagonists / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011804:Quinolines / Q000627:therapeutic use*; D013440:Sulfides
D000085:Acetates; D018927:Anti-Asthmatic Agents; D003521:Cyclopropanes; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D020024:Leukotriene Antagonists; D011804:Quinolines; D013440:Sulfides; D003520:Cyclophosphamide; C093875:montelukast