title: Churg-Strauss syndrome manifesting as perforation of the small intestine: report of a case.
abstract: We report a case of Churg-Strauss syndrome (CSS) causing perforation of the small intestine. A 51-year-old woman was admitted with an asthma attack and paralysis of both legs. Intravenous predonisolone (40 mg) was given to relieve her asthma. Laboratory data on admission showed leukocytosis with hypereosinophilia and a high level of serum IgE. Neurological examination also revealed mononeurutis multiplex. Based on these findings, we diagnosed CSS, and oral corticosteroids were continued. On the 20th day after admission, she suffered sudden abdominal pain. Abdominal X-ray showed free air in the abdomen, suggesting perforation of the gastrointestinal tract. Emergency laparotomy revealed generalized peritonitis caused by a perforated ulcer of the ileum. The resected specimens contained a perforation and multiple nonperforated ulcers with an irregular shape on the mucosal surface. Histopathological examinations revealed angiitis of the small vessels surrounded by eosinophilic infiltration and granuloma, consistent with CSS. Considering the high risk of perforation of the gastrointestinal tract, including the small intestine, during corticosteroid treatment in patients with CSS, any abdominal pain or discomfort must be investigated carefully.
authors.affiliation: Department of Surgery, Saitama Medical School, Morohonngo 38, Moroyama-machi, Saitama 350-0945, Japan.
authors.forename: Saburo
authors.initials: S
authors.lastname: Murakami
authors.forename: Misono
authors.initials: M
authors.lastname: Misumi
authors.forename: Hideto
authors.initials: H
authors.lastname: Sakata
authors.forename: Renzo
authors.initials: R
authors.lastname: Hirayama
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Kubojima
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Nomura
authors.forename: Shinnichi
authors.initials: S
authors.lastname: Ban
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D015267:Churg-Strauss Syndrome / Q000150:complications* / Q000188:drug therapy; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications / Q000209:etiology* / Q000601:surgery*; D007421:Intestine, Small / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology; D012307:Risk Factors
chemical_list: D000305:Adrenal Cortex Hormones