title: Churg-Strauss syndrome with necrosis of toe tips.
abstract: Churg-Strauss syndrome (CSS) is a granulomatous necrotizing vasculitis of unknown etiology associated with bronchial asthma. Despite affecting small to medium-sized vessels, necrosis of the digits due to vasculitis is extremely rare. We report a case of CSS with necrosis of the toe tips. A 37-year-old woman with asthma, who had been diagnosed with CSS 2 years ago, was admitted to our hospital with an exacerbation of CSS. The patient had a high grade fever and complained of abdominal pain and numbness of the lower extremities. Blood examination revealed marked eosinophilia. The fever pattern, abdominal pain and blood eosinophilia showed improvement by combination treatment with prednisolone and cyclophosphamide. However, the color of her right toe tips changed, and necrosis finally resulted despite antithrombotic therapy. Arteriography showed narrowing of the dorsalis pedis artery and of the more peripheral arteries of her right leg. Stump plasty with negative pressure dressing therapy for the toe tips, but not amputation, was done to preserve the leg function. While numbness of the extremities remained, no recurrence of necrosis was seen. Clinicians need to be aware that rare complications of CSS, including necrosis of the digits, can occur.
authors.affiliation: Department of Allergy and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Waseda
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Tanimoto
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Miyahara
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nojima
authors.forename: Genyo
authors.initials: G
authors.lastname: Ikeda
authors.forename: Arihiko
authors.initials: A
authors.lastname: Kanehiro
authors.forename: Chiharu
authors.initials: C
authors.lastname: Okada
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kimata
authors.forename: Mitsune
authors.initials: M
authors.lastname: Tanimoto
mesh_terms: D000328:Adult; D015267:Churg-Strauss Syndrome / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D009336:Necrosis / Q000209:etiology; D014034:Toes / Q000473:pathology*