Allergy Asthma Respir Dis.  2013 Dec;1(4):388-390. 10.4168/aard.2013.1.4.388.

Churg-Strauss syndrome presenting as acute acalculous cholecystitis

• Lee WJ
• Hwang JW
• Kim E
• Yune S
• Ha JM
• Yoon N
• Lee BJ
• Choi DC

• KMID: 2262599
• DOI: http://doi.org/10.4168/aard.2013.1.4.388

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.

Keyword

Churg-Strauss syndrome; Acalculous cholecystitis; Vasculitis

MeSH Terms

Abdominal Pain
Acalculous Cholecystitis*
Aged
Asthma
Cholecystectomy, Laparoscopic
Cholecystitis
Churg-Strauss Syndrome*
Emergencies
Eosinophilia
Eosinophils
Female
Gallbladder
Gastrointestinal Tract
Granuloma
Humans
Korea
Lung
Pathology
Sinusitis
Skin Manifestations
Systemic Vasculitis
Vasculitis

Figure

• 

  Fig. 1 Abdomen computed tomography. Gallbladder (arrow) shows mild wall thickening and elongation suggest of acute cholecystitis.

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  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).

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  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).

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