Acute cholecystitis and duodenitis associated with Churg-Strauss syndrome.
We describe a patient with acute cholecystitis and duodenitis associated with Churg-Strauss syndrome. A 36-year-old male, who had been healthy, had abdominal pain following high fever. He had marked hypereosinophilia of 17,000/mm3. Radiographs of the chest disclosed a transient infiltrated lesion in the left lower lung. Ultrasonographic and gastroendoscopic examinations revealed acute cholecystitis and duodenitis, respectively. Endoscopic retrograde cholangiopancreatography demonstrated a filling defect suspecting aberrant ascariasis in the common bile duct. The patient suddenly developed distally dominant mononeuritis multiplex, especially in the upper limbs. Muscle biopsy revealed vasculitis of intramuscular arteries with infiltration of eosinophils. These findings fulfilled the diagnostic criteria of Churg-Strauss syndrome. Corticosteroid dramatically resolved the abdominal symptoms. Cholecystectomy and removal of the foreign body were performed. Histological examinations revealed that necrosis of the gallbladder was caused by occlusion due to thrombosed arteries and that the foreign body in the common bile duct was an aggregate of necrotic epithelium of the bile duct wall surrounded by inflammatory cells. Although abdominal complaints rarely appeared as an initial symptom in the patients with Churg-Strauss syndrome, this syndrome should be taken into consideration for an accurate diagnosis when the patients with abdominal pain of unknown origin had eosinophilia, asthma, or allergic rhinitis.
Nishie
Makoto
M
Third Department of Internal Medicine, Institute of Brain Science, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki 036-8216, Japan. m-nishie@sd5.so-net.ne.jp
Tomiyama
Masahiko
M
Kamijo
Mikiko
M
Kannari
Kazuya
K
Tanosaki
Masato
M
Baba
Masayuki
M
Matsunaga
Muneo
M
Suda
Toshihiro
T
D000208:Acute Disease; D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002764:Cholecystitis / Q000209:etiology*; D015267:Churg-Strauss Syndrome / Q000150:complications* / Q000175:diagnosis; D004382:Duodenitis / Q000209:etiology*; D005704:Gallbladder / Q000473:pathology; D006801:Humans; D017681:Hypereosinophilic Syndrome / Q000209:etiology; D008297:Male; D020422:Mononeuropathies / Q000209:etiology; D009336:Necrosis