Churg-Strauss Syndrome

  • Medical Author:
    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Churg-Strauss syndrome facts

  • Churg-Strauss syndrome is a disease characterized by inflammation of the blood vessels.
  • Churg-Strauss syndrome occurs in patients with a history of asthma or allergy.
  • Symptoms of Churg-Strauss syndrome include fatigue, weight loss, nasal passage inflammation, numbness, and weakness.
  • The ultimate test for the diagnosis is a biopsy of involved tissue.
  • Treatment of Churg-Strauss syndrome involves stopping inflammation and suppressing the immune system.

What is Churg-Strauss syndrome?

Churg-Strauss syndrome is one of many forms of vasculitis. Vasculitis diseases are characterized by inflammation of blood vessels. Churg-Strauss syndrome, in particular, occurs in patients with a history of asthma or allergy and features inflammation of blood vessels (also referred to as angiitis) in the lungs, skin, nerves, and abdomen. The blood vessels involved in Churg-Strauss syndrome are small arteries and veins.

What causes Churg-Strauss syndrome?

Churg-Strauss syndrome is rare. The cause of the syndrome is not known, but it involves an abnormal over-activation of the immune system in a person with underlying bronchospastic lung disease (asthma). While Churg-Strauss syndrome has been reported to be associated with certain asthma medications, called leukotriene modifiers, whether they actually cause the disease or whether the patients that take them have more severe asthma that lends a tendency toward the development of Churg-Strauss is not yet clear.

Quick GuideAsthma Symptoms, Causes, and Medications

Asthma Symptoms, Causes, and Medications

What are symptoms of Churg-Strauss syndrome?

Churg-Strauss syndrome causes fever, weight loss, and sinus or nasal passage inflammation in the patient with asthma. Fatigue is common. Sometimes the asthma actually improves somewhat as the disease intensifies elsewhere. Cough, shortness of breath, and chest pain can occur as the lungs are affected by vasculitis.

Skin lumps, called nodules, can appear on the extremities. Diarrhea and pain in the belly occur due to blood vessel inflammation within the abdomen. The bladder and prostate gland can become inflamed.

Numbness or weakness of the extremities is the result of nerve injury from the vasculitis. If the brain is affected, seizures or confusion can occur.

How is Churg-Strauss syndrome diagnosed?

Churg-Strauss syndrome is suggested when the symptoms described above occur in a patient with a history of asthma.

Abnormalities of the lungs, skin, and nerves might be noted by the doctor during the examination. Blood pressure can be elevated.

Blood examination generally shows elevated levels of an uncommon white blood cell, called an eosinophil, and other white blood cells are also elevated in number. Kidney function blood tests and urinalysis can be abnormal when the kidneys are affected (which is not common).

If the lungs are inflamed, the chest x-ray image or CT scan of the chest can demonstrate areas of inflammation.

The ultimate test for the diagnosis is a biopsy of involved tissue, which demonstrates a characteristic pattern of inflammation visible under a microscope. Eosinophil are also seen accumulated in the abnormal tissue.

How is Churg-Strauss syndrome treated?

The treatment of patients with Churg-Strauss syndrome is directed toward both immediately quieting the inflammation of the blood vessels (vasculitis) and suppressing the immune system. Treatment usually includes high doses of cortisone-related medication (such as prednisone or prednisolone) to calm the inflammation and suppression of the active immune system with cyclophosphamide (Cytoxan).

Traditionally, cyclophosphamide has been given for a year or more in patients with Churg-Strauss syndrome. In a research study, Churg-Strauss syndrome patients did equally well if treated with cyclophosphamide for 6 or for 12 months. This study suggests that doctors might now be able to recommend a shorter (and, therefore, less toxic) course of Cytoxan for patients with Churg-Strauss syndrome.

What is the outlook (prognosis) for patients with Churg-Strauss syndrome?

Churg-Strauss syndrome is a serious disease that can be fatal. Untreated it is extremely dangerous and threatens the organs that are affected. With aggressive treatment and monitoring it can be quieted and total inactivation of the disease (remission) is possible.

Medically reviewed by Robert J. Bryg, MD; Board Certified Internal Medicine with subspecialty in Cardiovascular Disease

REFERENCE:

King, Talmadge E., MD. "Clinical features and diagnosis of eosinophilic granulomatosis with polyangiitis (Churg-Strauss)," UptoDate. Updated Jul 8, 2016.

Last Editorial Review: 9/15/2016

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Reviewed on 9/15/2016
References
Medically reviewed by Robert J. Bryg, MD; Board Certified Internal Medicine with subspecialty in Cardiovascular Disease

REFERENCE:

King, Talmadge E., MD. "Clinical features and diagnosis of eosinophilic granulomatosis with polyangiitis (Churg-Strauss)," UptoDate. Updated Jul 8, 2016.

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