A fifty-year-old female presented with a one month history of progressive
dyspnea, productive
cough,
pain of elbows and knees, and 40°C
fever despite
antibiotic treatment. She has been diagnosed of
bronchial asthma over 25 years before admission and oral and depot glucocorticosteroids as a long-term
therapy was applied. Recently, an attempt of inhaled
corticosteroids and LABA treatment was introduced with no success. Four years before admission she also developed
peripheral neuropathy. Physical examination revealed
tachypnea, wheezes,
rhonchi and wet cracles on auscultation, tachy?cardia, skin nodules, urticarial
rash and necrotic
bullae all over the body. Chest X-ray showed transient, patchy, nonsegmental areas of consolidation with predilection for lower zones with the area of consolidation in lower left zone. Obstruction was found on spirometry. Tachy?cardia on ECG and myocardial fluid on ECHO were also detected. Lab exams revealed elevated CRP, WBC, eosinophils, and
IgE levels. ANA and
ANCA antibodies were not found. Patient was diagnosed of
Churg Strauss Syndrome and initial treatment of
prednisone was introduced. After four days of treatment, temperature normalized, and
dyspnea diminished. After one month of
therapy skin lesions regressed. After 18 months of the treatment patient reports no signs, nor symptoms of the disease. Patient continues oral
corticosteroid therapy.