Montelukast and Churg-Strauss syndrome.
The association of leukotriene receptor antagonists and Churg-Strauss Syndrome (CSS) has been recognised for several years. However, whether these drugs have a direct pathogenic role remains controversial. The present case describes an asthmatic patient, who developed severe obstructive symptoms and progressive heart failure after two sequential exposures to montelukast. As the patient exhibited a markedly raised blood eosinophil count with diffuse infiltrates on chest x-ray and signs of myocarditis, CSS was suspected. The disease was confirmed by open lung biopsy. The symptoms improved rapidly after administration of high dose immunosuppression with methylprednisolone and cyclophosphamide. This case is noteworthy because the time course of events strongly suggests a direct aetiological role for montelukast in the development of CSS. The pathophysiological mechanism of the association remains unknown.
Conen
David
D
Department of Internal Medicine, University Hospital Basel, Switzerland. conend@uhbs.ch
Leuppi
Jörg
J
Bubendorf
Lukas
L
Ronsdorf
Anke
A
Tamm
Michael
M
Hauser
Thomas
T
D000085:Acetates / Q000009:adverse effects* / Q000627:therapeutic use; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy; D001707:Biopsy, Needle; D015267:Churg-Strauss Syndrome / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D003521:Cyclopropanes; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D020024:Leukotriene Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011657:Pulmonary Eosinophilia / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D011804:Quinolines / Q000009:adverse effects* / Q000627:therapeutic use; D013902:Radiography, Thoracic; D018570:Risk Assessment; D012720:Severity of Illness Index; D013440:Sulfides; D013557:Switzerland; D016896:Treatment Outcome
D000085:Acetates; D003521:Cyclopropanes; D007166:Immunosuppressive Agents; D020024:Leukotriene Antagonists; D011804:Quinolines; D013440:Sulfides; C093875:montelukast