title: Successful multidrug treatment of a pediatric patient with severe Churg-Strauss syndrome refractory to prednisolone.
abstract: Churg-Strauss syndrome (CSS), which is characterized by systemic small-vessel vasculitis of unknown etiology, is associated with a history of asthma. Although reports of CSS occurring in children are limited, effective treatment of pediatric patients with severe CSS remains challenging. A 10-year-old Japanese boy with a 6-month history of asthma treated with a leukotriene modifier, pranlukast, developed high fever, pleural infiltration, and pericarditis that were associated with marked hypereosinophilia (10,350 eosinophils/µl). Owing to his persistent high fever, mononeuritis multiplex, and severe abdominal pain that was refractory to prednisolone, his general condition progressively deteriorated thereafter. Although intravenous high-dose immunoglobulin administration was transiently effective for mononeuritis multiplex, the recurrent high fever and severe abdominal pain remained refractory. An endoscopic study revealed ulcerative lesions of the total colon. In this context, we treated the patient with an aggressive multidrug immunosuppressive regimen consisting of a high-dose methylprednisolone pulse plus short-course intravenous cyclophosphamide pulse therapy, followed by oral tacrolimus combined with prednisolone. After the rescue multidrug treatment, his severe clinical signs dramatically subsided within a short time, and the concomitantly administered prednisolone was successfully tapered without flare. At present, 12 months after the presentation, he is free from CSS signs or therapy-related toxicity except for an occasional mild asthma attack. Although further close observation should be needed to draw a long-term outcome in this patient, we believe that aggressive multidrug immunosuppressive treatment should be considered as an alternative rescue treatment in selected patients with severe CSS, even with pediatric-onset disease, that is refractory to prednisolone.
authors.affiliation: Department of Pediatrics, Hirosaki University Hospital, Hirosaki, Japan.
authors.forename: Shojiro
authors.initials: S
authors.lastname: Watanabe
authors.forename: Tomomi
authors.initials: T
authors.lastname: Aizawa-Yashiro
authors.forename: Kazushi
authors.initials: K
authors.lastname: Tsuruga
authors.forename: Toru
authors.initials: T
authors.lastname: Takahashi
authors.forename: Etsuro
authors.initials: E
authors.lastname: Ito
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tanaka
mesh_terms: D018927:Anti-Asthmatic Agents / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001249:Asthma / Q000150:complications; D002648:Child; D002867:Chromones / Q000627:therapeutic use; D015267:Churg-Strauss Syndrome / Q000188:drug therapy* / Q000473:pathology; D003520:Cyclophosphamide / Q000008:administration & dosage; D004351:Drug Resistance; D018432:Drug Resistance, Multiple; D004802:Eosinophilia / Q000150:complications; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007564:Japan; D008775:Methylprednisolone / Q000008:administration & dosage; D010493:Pericarditis / Q000150:complications; D010994:Pleura / Q000473:pathology; D011239:Prednisolone / Q000627:therapeutic use*; D016559:Tacrolimus / Q000008:administration & dosage; D014456:Ulcer / Q000473:pathology
chemical_list: D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents; D002867:Chromones; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D011239:Prednisolone; C047681:pranlukast; D016559:Tacrolimus; D008775:Methylprednisolone