Tuberc Respir Dis.  2009 Mar;66(3):225-229. 10.4046/trd.2009.66.3.225.

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

• Kim JE
• Kim KU
• Park HK
• Jeon DS
• Kim YS
• Lee MK
• Park SK

• KMID: 1846385
• DOI: http://doi.org/10.4046/trd.2009.66.3.225

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.

Keyword

Churg-Strauss syndrome; Acute cholecystitis; Diffuse alveolar hemorrhage

MeSH Terms

Acalculous Cholecystitis
Asthma
Biopsy
Bronchoalveolar Lavage
Cholecystitis, Acute
Churg-Strauss Syndrome
Edema
Female
Glass
Hemorrhage
Humans
Lung
Mononeuropathies
Neural Conduction
Skin
Systemic Vasculitis
Urinary Bladder
Vasculitis
Young Adult

Figure

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  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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