title: Churg-Strauss syndrome (CSS) manifested as necrosis of fingers and toes and liver infarction.
abstract: We report a case of Churg-Strauss syndrome (CSS) with necrosis of the fingers and toes and liver infarction. A 59-year-old man with asthma suddenly noticed that his fingers and toes felt unusually cold. This condition worsened progressively, and some digits became necrotic within several weeks. Laboratory studies revealed hypereosinophilia and an extremely elevated serum level of IgE. Digital subtraction angiography of the extremities revealed extensive irregular narrowing of small and medium-sized arteries in the extremities. Abdominal computed tomography (CT) revealed an area of low density at the periphery of the right lobe of the liver. Angiography revealed irregular narrowing of small arteries that corresponded to the ischemic area. A nerve conduction study suggested sensory nerve neuropathy. The preceding asthma, acute onset of digital necrosis, liver infarction, neuropathy, and hypereosinophilia strongly suggested a diagnosis of CSS. The patient was treated with 40 mg of prednisolone and 120 micro g of intravenous prostaglandin E1 daily, and all the digits that had turned black and necrotic were amputated. After the amputation, the dose of prednisolone was gradually reduced, and no new lesions appeared on the skin or in the liver. The rare possible complications of CSS, including necrosis of digits and liver infarction, should not be ignored.
authors.affiliation: Department of Anatomy, Biology, and Medicine (Dermatology), Oita Medical University, Oita, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Otani
authors.forename: Saburo
authors.initials: S
authors.lastname: Anzai
authors.forename: Hiromi
authors.initials: H
authors.lastname: Shibuya
authors.forename: Sakuhei
authors.initials: S
authors.lastname: Fujiwara
authors.forename: Susumu
authors.initials: S
authors.lastname: Takayasu
authors.forename: Yuji
authors.initials: Y
authors.lastname: Asada
authors.forename: Hiroto
authors.initials: H
authors.lastname: Terashi
authors.forename: Masahisa
authors.initials: M
authors.lastname: Takuma
authors.forename: Shigeo
authors.initials: S
authors.lastname: Yokoyama
mesh_terms: D000527:Alprostadil / Q000008:administration & dosage; D000671:Amputation, Surgical; D000792:Angiography; D015267:Churg-Strauss Syndrome / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D003937:Diagnosis, Differential; D005385:Fingers / Q000473:pathology / Q000601:surgery; D006801:Humans; D007238:Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D008099:Liver / Q000098:blood supply; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011239:Prednisolone / Q000008:administration & dosage; D014034:Toes / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed
chemical_list: D011239:Prednisolone; D000527:Alprostadil