title: Churg-Strauss syndrome concomitant with chronic symmetrical dacryoadenitis suggesting Mikulicz's disease.
abstract: A case of Churg-Strauss syndrome complicated by chronic symmetrical dacryoadenitis suggestive of Mikulicz's disease is herein presented. A 72-year-old Japanese man, who had been previously diagnosed with asthma, presented with weakness of the left leg and purpura on the lower extremities. A neurological examination showed multiple mononeuropathies and a laboratory examination revealed elevated eosinophil counts, IgE levels and the presence of Myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCAs). Churg-Strauss syndrome was diagnosed, although the patient also exhibited bilateral swelling of the lachrymal glands. Furthermore, elevated serum IgG4 levels, an infiltration of a relatively large number of IgG4-positive plasmacytes in the nasal mucosa and hypocomplementemia were also observed. These findings were consistent with a diagnosis of Mikulicz's disease (MD). Oral prednisolone (30 mg) was administered and the swelling of the lachrymal glands resolved. Churg-Strauss syndrome may be accompanied by Mikulicz's disease (an IgG4-related disease), and common pathogeneses between Churg-Strauss syndrome and IgG4-related disease may exist.
authors.affiliation: Department of Internal Medicine, Osaka City General Hospital, Japan. la_sa_sya@hotmail.com
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Hanioka
authors.forename: Keiko
authors.initials: K
authors.lastname: Yamagami
authors.forename: Katsunobu
authors.initials: K
authors.lastname: Yoshioka
authors.forename: Tomomi
authors.initials: T
authors.lastname: Nakamura
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Kishida
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Nakamura
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Naomi
authors.initials: N
authors.lastname: Koshimo
authors.forename: Takeshi
authors.initials: T
authors.lastname: Inoue
authors.forename: Masahito
authors.initials: M
authors.lastname: Imanishi
mesh_terms: D000368:Aged; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D015267:Churg-Strauss Syndrome / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D003607:Dacryocystitis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007765:Lacrimal Apparatus / Q000473:pathology; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008882:Mikulicz' Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D010950:Plasma Cells / Q000473:pathology; D011239:Prednisolone / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D007074:Immunoglobulin G; D016756:Immunoglobulins, Intravenous; D007073:Immunoglobulin E; D011239:Prednisolone; D008775:Methylprednisolone