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Lee, Hwang, Kim, Yune, Ha, Yoon, Lee, and Choi: Churg-Strauss syndrome presenting as acute acalculous cholecystitis
Case Report

Allergy, Asthma & Respiratory Disease 2013; 1(4): 388-390.

Published online: 31 December 2013

DOI: https://doi.org/10.4168/aard.2013.1.4.388

Churg-Strauss syndrome presenting as acute acalculous cholecystitis

Woo Joo Lee1, Ji-Won Hwang1, Eun Kim1, Sehyo Yune1, Jung Min Ha1, Nara Yoon2, Byung Jae Lee1, 3, Dong Chull Choi1, 3

1Department of Internal Medicine, Samsung Medical Center, Seoul, Korea.

2Department of Pathology, Samsung Medical Center, Seoul, Korea.

3Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.

Correspondence to: Dong Chull Choi. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. Tel: +82-2-3410-3422, Fax: +82-2-3410-1730, dcchoi@skku.edu

Received 23 July 2013       Revised 29 July 2013       Accepted 6 August 2013

© 2013 The Korean Academy of Pediatric Allergy and Respiratory Disease; The Korean Academy of Asthma, Allergy and Clinical Immunology

(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

Churg-Strauss syndrome (CSS) is a rare systemic vasculitis. It is characterized by peripheral eosinophilia, asthma, neuropathy, skin manifestation, and less frequently gastrointestinal tract symptoms. Here we report a case of CSS which is initially manifested as acute acalculous cholecystitis. A 67-year-old asthmatic woman visited Emergency Room because of acute abdominal pain. Computed tomography showed acalculous cholecystitis and laparoscopic cholecystectomy was done. Pathology of gallbladder showed marked eosinophilic infiltration with necrotizing vasculitis and granuloma. On the basis of asthma, sinusitis, lung infiltration, combined peripheral eosinophilia and neuropathy, the patient was diagnosed as CSS. To our knowledge, this is the first case of pathologically proven eosinophilic cholecystitis in Korea.

Keywords: Churg-Strauss syndrome, Acalculous cholecystitis, Vasculitis

Figures and Tables

Fig. 1
Abdomen computed tomography. Gallbladder (arrow) shows mild wall thickening and elongation suggest of acute cholecystitis.
aard-1-388-g001
Fig. 2
Pathology of gallbladder shows necrotizing vasculitis with fibrinoid necrosis (A, arrow) and necrotizing granuloma centered on necrotic eosinophils (B, arrow). The background of this specimen shows eosinophilic inflammation (H&E, ×400).
aard-1-388-g002
Fig. 3
Pathology of skin and sural nerve. (A) Leukocytoclastic vasculitis of skin with numerous eosinophils (H&E, ×400). (B) Necrotizing vasculitis of nerve with marked loss of myelinated fibers (H&E, ×200).
aard-1-388-g003

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