Churg-Strauss

The patient with worsening asthma who develops fever and evidence of a systemic illness.

• in patients with asthma or history of allergy
• presents with an increase in allergic manifestations (ie asthma), followed by eosinophilia, then vasculitis
• other early sx: fever, malaise, wt loss
• as vasculitis develops, asthma may become less prominent
• skin: petechieas, purpura, ulcerations
• peripheral neuropathy (multiple mononeuropathies) is common
• ischemia or infarction of abdominal organs: diarhhea, pain, mass
• develops in middle age and men more commonly
• involvement of lungs helps distinguish it from polyarteritis nodosa; renal lesions are less severe than PAN
• eosinophilic granulamatous involvement  of the GI and urinary tracts is a unique feature

Labs

• eosinophilia  is present in essentially all, but resolves in response to tx
• serum complement usually normal
• renal fn may be diminished; +/- proteinuria, RBC casts
• CXR: patchy or nodular infiltrates or diffuse interstitial dz

Dx

• confirm by bx of involved tissues

DDX

• Loffler's syndrome
• hypersensitivity vasculitis
• Wegener granulomatosis

Primer of the Rheumatic diseases. 11th ed.