title: Successful treatment of a patient with severe Churg-Strauss syndrome by a combination of pulse corticosteroids, pulse cyclophosphamide, and high-dose intravenous immunoglobulin.
abstract: A 24-year-old woman with a 4-year history of bronchial asthma suffered from bloody sputum, numbness of the extremities, elevated eosinophil count, and hypoxemia. A diagnosis of alveolar hemorrhage was made by bronchoalveolar lavage. Echocardiogram revealed severe hypokinesis of the left ventricular wall. Her respiratory condition deteriorated despite administration of pulse corticosteroids. A second pulse corticosteroids and pulse cyclophosphamide followed by high-dose intravenous immunoglobulin brought about a dramatic improvement of alveolar hemorrhage, cardiac impairment, and peripheral neuropathy. Levels of antimyeloperoxidase-antineutrophil cytoplasmic antibodies, soluble thrombomodulin, soluble interleukin-2 receptor, eosinophil cationic protein were elevated and returned to the normal range in remission. The combination of pulse corticosteroids, pulse cyclophosphamide, and high-dose intravenous immunoglobulin seemed effective for the acute phase of severe Churg-Strauss syndrome.
authors.affiliation: Department of Internal Medicine, National Hospital Organization, Minami-Okayama Medical Center, Okayama, Japan. takigawan@s-okayama.hosp.go.jp
authors.forename: Nagio
authors.initials: N
authors.lastname: Takigawa
authors.forename: Noriko
authors.initials: N
authors.lastname: Kawata
authors.forename: Takuo
authors.initials: T
authors.lastname: Shibayama
authors.forename: Atsuhiko
authors.initials: A
authors.lastname: Tada
authors.forename: Goro
authors.initials: G
authors.lastname: Kimura
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Munemasa
authors.forename: Ryo
authors.initials: R
authors.lastname: Soda
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Takahashi
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D001249:Asthma / Q000188:drug therapy; D015267:Churg-Strauss Syndrome / Q000188:drug therapy*; D003520:Cyclophosphamide / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007155:Immunologic Factors / Q000008:administration & dosage*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D012720:Severity of Illness Index
chemical_list: D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide