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Kim, Kim, Park, Jeon, Kim, Lee, and Park: A Case of Churg-Strauss Syndrome with Diffuse Alveolar Hemorrhage Presenting as Acute Acalculous Cholecystitis
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2009; 66(3): 225-229.

Published online: 31 March 2009

DOI: https://doi.org/10.4046/trd.2009.66.3.225

A Case of Churg-Strauss Syndrome with Diffuse Alveolar Hemorrhage Presenting as Acute Acalculous Cholecystitis

Ji Eun Kim, M.D., Ki Uk Kim, M.D., Hye-Kyung Park, M.D., Doo Soo Jeon, M.D., Yun Sung Kim, M.D., Min Ki Lee, M.D., Soon Kew Park, M.D.

Department of Internal Medicine, Pusan National University College of Medicine, Busan, Korea.

Address for correspondence: Hye-Kyung Park, M.D. Department of Internal Medicine, College of Medicine, Pusan National University, 1-10, Ami-dong, Seo-gu, Busan 602-739, Korea. Phone: 82-51-240-7889, Fax: 82-51-254-3127, parkhk@pusan.ac.kr

Received 6 January 2009       Accepted 6 March 2009

Copyright©2009. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Churg-Strauss syndrome (CSS) is a disorder that is characterized by asthma, hypereosinophilia and systemic vasculitis affecting a number of organs. The manifestations of acute cholecystitis and diffuse alveolar hemorrhage are rarely reported in CSS. A 22-year-old woman with bronchial asthma visited our hospital complaining of right upper quadrant pain with a sudden onset. The abdominal computed tomography (CT) scan revealed gall bladder edema consistent with acute cholecystitis. On the initial evaluation, marked hypereosinophilia was observed in the peripheral blood smear. The nerve conduction velocity measurements and a skin biopsy performed to confirm the organ involvement of disease indicated typical mononeuritis multiplex and necrotizing vasculitis, respectively, which was complicated with CSS. On the 12th hospital day, ground glass opacity and consolidations were newly developed on both lung fields. The bronchoalveolar lavage (BAL) fluid showed increasing bloody return in sequential aliquots that were characteristic of a diffuse alveolar hemorrhage. We report a case of CSS with acute cholecystitis and diffuse alveolar hemorrhage.

Keywords: Churg-Strauss syndrome, Acute cholecystitis, Diffuse alveolar hemorrhage

Figures and Tables

Figure 1
US abdomen of shows edematous gall bladder wall without stone.
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Figure 2
Abdomen CT scan shows gall bladder wall thickening without stone which suggests achalculous cholecystitis.
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Figure 3
Microscopic findings of skin biopsy. (A) Infiltration of inflammatory cells were seen from the dermis to subcutaneous fat tissue (H&E stain, ×40). (B) Vascular wall was destroyed and showed fibrinoid change which means vasculitis. Numerous infiltrated eosinophils were also seen (H&E stain, ×400).
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Figure 4
(A) Chest X-ray at hospital day 12 shows ground glass opacities and patchy consolidation in both lung field. (B) Chest CT scan shows lobular consolidation and ground glass opacities on both lung. Some centrilobular nodules were also seen. Lobular consolidation was mainly located at peripheral portion of both lungs. (C) Chest X-ray after treatment with methylprednisolone.
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Notes

This work was supported by 2007 Pusan National University Hospital Clinical Research Grant.

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