Clinical Case Database / Category: Patient Management

Weakness and wheezing in a young woman

Publication details

Kaushik Sanyal, Katie Moss, Nidhi Sofat
Foundation Years Journal, volume 6, issue 2, p.19 (123Doc Education, London, February 2012)

Abstract

A 32-year old Asian woman presented with a 2-week history of weakness and tingling in her right arm and leg. She also reported a rash over her right leg. She had a past medical history of asthma. Clinical examination revealed an erythematous rash over her lower leg. On chest auscultation she had fine bibasal inspiratory crackles. Blood results showed raised inflammatory markers, a peripheral blood eosinophilia and a negative ANCA. A high resolution CT chest showed ground glass shadowing consistent with interstitial lung disease. A biopsy of the skin rash demonstrated eosinophilic vasculitis. Based on these findings, a diagnosis of Churg-Strauss vasculitis was made. The patient responded well to intravenous corticosteroid and cyclophosphamide therapy with rapid resolution of her vasculitis.

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Authors

Kaushik Sanyal

Specialist Registrar in Rheumatology
Department of Rheumatology
St George’s Hospital NHS Trust
Blackshaw Road
London SW17 OQT

Katie Moss

Consultant Rheumatologist
Department of Rheumatology
St George’s Hospital NHS Trust
Blackshaw Road
London SW17 OQT

Nidhi Sofat (Corresponding author)

Consultant Rheumatologist and Clinical Senior Lecturer
Department of Rheumatology
St George’s Hospital NHS Trust
Blackshaw Road
London SW17 OQT
nsofat@sgul.ac.uk

References

1. Masi AT, Hunder GG, Lie JT, Michel BA, Arend WP, Calabrese LH, Edworthy SM, Fauci AS, Leavitt RY, et al .The American College of Rheumatology 1990 Criteria for the classification of Churgh –Strauss Syndrome (allergic granulomatosis and angiitis) Arthritis Rheum 1990; 33(8): 1094
2. Sable-Fourtassou R, Cohen P, Mahr A, et al. Antineutrophil cytoplasmic antibodies and the Churg-Strauss syndrome. Ann Intern Med 2005; 143: 632
3. Sinico RA, Di Toma L, Maggiore U, et al .Prevalence and clinical significance of antineutrophil cytoplasmic antibodies in Churg–Strauss syndrome. Arthritis Rheum 2005; 2: 2926
4. Terrier B, Saadoun D, Sène D et al. Antimyeloperoxidase antibodies are useful marker of disease activity in ANCA associated vasculitides. Annals of Rheumatic Diseases. 2009; 68(10): 1564-71.
5. Lanham JG, Elkon KB, Pusey CD, Hughes GR. Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome. Medicine (Baltimore) 1984: 63(2): 65-81
6. Guillevin L, Jarrome B, Lok C et al. Long term follow-up after treatment of PAN and Churg-Strauss angiitis with comparison of steroids, plasma exchange and cyclophosphamide to steroids and plasma exchange: A prospective randomised trail of 71 patients. J Rheumatol 1991; 18 (4): 567-74.
7. Roccatello D, Baldovino S et al. Effects of anti-CD20 monoclonal antibody as a rescue treatment for ANCA associated idiopathic systemic Vasculitis. Clinical and Experimental Rheumatology. 2008; 3 Supplement 49: S67 -71

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About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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