Asthma associated with worsening leg ulcer: a case of vasculitis in primary care.
A 71-year-old black woman was admitted to the hospital with a 2-month history of a nonhealing leg ulcer. Her medical history included diabetes mellitus type 2, congestive heart failure, allergic rhinitis, and asthma. The patient's asthma was labile and steroid-dependent until 2 years before admission, at which time zafirlukast therapy was started. On further questioning, the patient revealed a 6-month history of malaise and a 40-lb weight loss. A physical examination showed a 2-cm Stage 3 ulcer on the medial aspect of the right ankle with diminished sensation in both feet and left footdrop. Electromyography revealed mononeuritis multiplex. The patient's white blood cell count was 11,100/mm3 with 60% eosinophils. A sural nerve biopsy showed vasculitis consistent with Churg-Strauss syndrome. One week after prednisone therapy was initiated, the patient's foot strength was nearly normal and her eosinophilia had resolved. Although Churg-Strauss syndrome is a rare disorder, in the setting of asthma and multiple disparate signs and symptoms, the broad diagnostic category of serious vasculitic illness should be considered.
Cakir
Beril
B
Internal Medicine Program, Moses Cone Hospital, 1200 N. Elm Street, Greensboro, NC 27401, USA.
Cykert
Samuel
S
D000368:Aged; D018927:Anti-Asthmatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D001706:Biopsy; D015267:Churg-Strauss Syndrome / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007211:Indoles; D007871:Leg Ulcer / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology; D009131:Muscle, Smooth, Vascular / Q000473:pathology; D048448:Phenylcarbamates; D013449:Sulfonamides; D013497:Sural Nerve / Q000098:blood supply / Q000473:pathology; D014105:Tosyl Compounds / Q000009:adverse effects* / Q000627:therapeutic use; D014650:Vasa Nervorum / Q000473:pathology
D018927:Anti-Asthmatic Agents; D007211:Indoles; D048448:Phenylcarbamates; D013449:Sulfonamides; D014105:Tosyl Compounds; C062735:zafirlukast