Churg-Strauss syndrome (allergic granulomatous angitis) presenting with ileus caused by ischemic ileal ulcer |
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Authors: | Toshimichi Kaneki Akira Kawashima Toshihide Hayano Takayuki Honda Keishi Kubo Tomonobu Koizumi Morie Sekiguchi Hideyuki Ichikawa Kenji Matsuzawa Tsutomu Katsuyama |
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Institution: | (1) First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390, Japan, JP;(2) First Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390, Japan, JP;(3) Department of Laboratory Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390, Japan, JP |
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Abstract: | We report a rare case of Churg-Strauss syndrome (CSS) in a 41-year-old Japanese man with a history of middle-age onset of
bronchial asthma who had severe abdominal pain. He presented with ileus caused by an annular ulcer of the ileum, attributable
to mucosal ischemia resulting from necrotizing vasculitis of the mesenteric artery. He also had marked hypereosinophilia (51.5%),
elevated serum IgE levels (34040 IU/ml), and generalized enlargement of the superficial cervical lymph nodes, containing eosinophilic
granulomas. A stenotic lesion caused by an annular ulcer in the ileum was found and resected by laparotomy. Microscopic examination
of the resected specimen revealed luminal narrowing or occlusion of small arteries in the ulcer base, subserosa, and mesenterium
resulting from marked fibrotic intimal thickening with fragmentation or lack of the internal elastic lamina. These findings
were diagnosed as vasculitis, scar stage. The postoperative course was uneventful, with the patient receiving a maintenance
dose of prednisolone (10–15 mg/day) for 7 years subsequently. We must carefully diagnose and treat patients with middle-age
onset asthma, because the symptom may be a lung manifestation of CSS, in which various organs including gastrointestinal tract
are involved as a result of systemic necrotizing vasculitis.
Received Jan. 30, 1997; accepted June 27, 1997 |
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Keywords: | : Churg-Strauss syndrome allergic granulomatous angitis ileus intestinal ulcer |
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