Churg-Strauss syndrome. Development of cardiomyopathy during corticosteroid treatment
M. M. Wishnick, Q. Valensi, E. F. Doyle, A. Balian, N. B. Genieser and G. Chrousos
A patient with Churg-Strauss syndrome had pulmonary lesions, vasculitis,
gastrointestinal tract involvement, and leukocytosis with
hypereosinophilia. A wedge section from the lung showed necrotizing
granulomata filled with necrotic eosinophils and fibrinoid, and rimmed by
giant cells and eosinophils. Arteries and veins of all sizes were affected
with perivascular eosinophilic-rich, palisaded, giant cell granulomata with
evidence of partial or complete occlusion. The patient was treated with
prednisone, with excellent resolution of his symptoms. Recurrent episodes
of pneumonia and wheezing responded to increased levels of prednisone plus
bronchodilators and antibiotics. Cardiomyopathy developed after two years
while taking prednisone. His condition has been managed with digoxin,
diuretics, and increased amount of prednisone. Although our patient has
shown clinical improvement in his cardiac status, objective studies show
minimal resolution.
