A case of churg-strauss syndrome: evidence of eosinophilic vasculitis on liver biopsy

Hyoung Sang Kim; Hyung Ki Jeong; Dong-Hyun Kim; Jieun Yu; Young Kim; Young-Il Koh

doi:10.4168/aard.2013.1.2.164

Journal List > Allergy Asthma Respir Dis > v.1(2) > 1058951

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Kim, Jeong, Kim, Yu, Kim, and Koh: A case of churg-strauss syndrome: evidence of eosinophilic vasculitis on liver biopsy

Case Report

Allergy, Asthma & Respiratory Disease 2013; 1(2): 164-167.

Published online: 27 June 2013

DOI: https://doi.org/10.4168/aard.2013.1.2.164

A case of churg-strauss syndrome: evidence of eosinophilic vasculitis on liver biopsy

Hyoung Sang Kim¹, Hyung Ki Jeong¹, Dong-Hyun Kim¹, Jieun Yu¹, Young Kim², Young-Il Koh¹

¹Department of Allergy, Asthma and Clinical Immunology, Chonnam National University Medical School, Gwangju, Korea.

²Department of Pathology, Chonnam National University Medical School, Gwangju, Korea.

Correspondence to: Young-Il Koh. Department of Allergy, Asthma and Clinical Immunology, Chonnam National University Hospital, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 501-757, Korea. Tel: +82-62-220-6580, Fax: +82-62-225-8578, yikoh@chonnam.ac.kr

Received 27 November 2012 Revised 28 January 2013 Accepted 28 January 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

Purpose

Churg-Strauss syndrome (CSS) is a rare disease characterized by pulmonary and systemic small vessel necrotizing vasculitis and peripheral blood eosinophilia occurring in asthmatics. Cases of CSS with hepatic involvement have been rarely reported. Here, we reported a case of CSS involving liver, in which liver biopsy revealed eosinophilic vasculitis.

Methods

A 75-year-old man complained of dyspnea and hemoptysis. He had severe blood eosinophilia (white blood cell 28,320/µL, eosinophils 79%). Computed tomography of chest and abdomen showed infiltrations in lungs and multifocal infiltrations in both hepatic lobes. Methacholine PC₂₀ was 2.89 mg/mL, which was in asthmatic range.

Results

Ultrasonography-guided liver biopsy was performed, showing eosinophilic vasculitis and portal granulomas. CSS can be diagnosed based on evidence of asthma, blood eosinophilia, pulmonary infiltration and vasculitis on biopsy.

Conclusion

Taken together, in a suspected case of CSS presenting as hepatic involvement, liver biopsy may be useful to demonstrate the presence of vasculitis.

Keywords: Churg-Strauss syndrome, Liver, Biopsy, Vasculitis

Figures and Tables

Fig. 1

Chest computed tomography shows multiple small nodules with surrounding ground grass opacities (A) and pericardial effusion (B).

Fig. 2

Abdomen computed tomography shows multiple low attenuated lesions at both hepatic lobes.

Fig. 3

Liver biopsy shows diffuse eosinophilic infiltration (A) and eosinophilic vasculitis (B, arrows) (H&E, ×200).

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