fluticasone and Churg-Strauss-Syndrome

This case report demonstrates that interleukin (IL)-5 levels and eosinophil cationic protein (ECP) correlated well with disease activity of Churg-Strauss syndrome (CSS) in a patient receiving treatment with leucotriene receptor antagonist and inhaled corticosteroid. In addition, ECP was localized in the inflamed tissue. IL-5 levels may thus provide a clue to therapeutic efficacy in patients with CSS using leucotriene receptor antagonists and inhaled corticosteroid.

Topics: Adult; Androstadienes; Anti-Asthmatic Agents; Anti-Inflammatory Agents; Chromones; Churg-Strauss Syndrome; Drug Therapy, Combination; Eosinophil Cationic Protein; Fluticasone; Humans; Interleukin-5; Leukotriene Antagonists; Receptors, Interleukin-2; Severity of Illness Index; Treatment Outcome

Allergic granulomatous vasculitis, or Churg-Strauss syndrome, is a small vessel, multisystem vasculitis that can affect multiple organs. It is usually idiopathic, but recent case reports have implicated leukotriene receptor antagonists (LTRA) and inhaled corticosteroids in the development of this rare syndrome. We report a case that acutely developed skin-limited Churg Strauss-like cutaneous allergic granulomatous vasculitis after initiating therapy with inhaled fluticasone and salmeterol for poorly controlled asthma symptoms. Our result thus highlights the importance of keeping the differential diagnosis of drug-induced Churg-Strauss syndrome in patients who have recently been prescribed inhaled steroids like fluticasone when they present with rashes of varying severity.

Topics: Administration, Inhalation; Adult; Androstadienes; Anti-Inflammatory Agents; Asthma; Churg-Strauss Syndrome; Female; Fluticasone; Humans; Vasculitis, Leukocytoclastic, Cutaneous

Two patients, 60 (pat. 1; female) and 30 years of age (pat. 2; male), respectively, suffering from a histologically confirmed Churg-Strauss-syndrome and receiving immunosuppressive therapy were treated with Interferon-alpha.. Clinical complaints, disease activity, blood eosinophil counts, and lung function were monitored. In patient 1 the differential cell counts and immunocytology of bronchoalveolar lavage cells were assessed using flow cytometry.. Both patients were treated with interferon-alpha in dosages of 3 million units of IFN-alpha 2b or an equivalent dosage of interferon-acon thrice weekly subcutaneously. The patients were observed for a period of up to 24 months. Interferon-alpha induced remission of disease and allowed discontinuation of oral glucocorticoid therapy in both patients. Treatment also improved the peripheral polyneuropathia in patient 1 as well as the hemorrhagic cystitis and reduction of the Cushing syndrome (weight reduction of 19 kg) in patient 2. In addition, blood eosinophil counts normalised. After 12 months of treatment, the number of bronchoalveolar eosinophils decreased from 61,5% (5.7 x 106 cells/ml) to 7% (1.1 x 106 cells/ml). In addition, the proportion of CD4+ T-lymphocytes and B-cells increased, while CD8+ T-cells and NK cells decreased (pat. 1).. Interferon-alpha may represent an effective alternative to the current treatment of Churg-Strauss syndrome consisting of corticosteroids and immunosuppressives.

Topics: Administration, Oral; Adult; Androstadienes; Bronchoalveolar Lavage Fluid; Cell Count; Churg-Strauss Syndrome; Female; Fluticasone; Glucocorticoids; Humans; Immunosuppressive Agents; Injections, Subcutaneous; Interferon alpha-2; Interferon Type I; Interferon-alpha; Male; Middle Aged; Prednisolone; Recombinant Proteins; Treatment Outcome

Allergic granulomatous vasculitis, or Churg-Strauss syndrome, is a small-vessel, multisystem vasculitis that can affect the skin, lungs, heart, and nervous system. Recent reports have implicated leukotriene receptor antagonists and inhaled corticosteroids in the development of this rare syndrome. We present a patient with no history of allergic asthma who acutely developed skin-limited Churg-Strauss-like granulomatous vasculitis after initiating therapy with inhaled fluticasone and salmeterol (Advair Diskus).

Topics: Androstadienes; Churg-Strauss Syndrome; Fluticasone; Humans; Male; Middle Aged; Vasculitis, Leukocytoclastic, Cutaneous

Topics: Administration, Inhalation; Adult; Androstadienes; Anti-Asthmatic Agents; Asthma; Churg-Strauss Syndrome; Drug Administration Schedule; Drug Therapy, Combination; Female; Fluticasone; Humans; Leukotriene Antagonists; Male; Middle Aged; Prednisone

Topics: Administration, Inhalation; Androstadienes; Anti-Inflammatory Agents; Churg-Strauss Syndrome; Fluticasone; Heart Failure; Humans; Male; Middle Aged; Prednisolone

Topics: Acetates; Administration, Inhalation; Androstadienes; Anti-Asthmatic Agents; Anti-Inflammatory Agents; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Dose-Response Relationship, Drug; Eosinophilia; Fluticasone; Humans; Nebulizers and Vaporizers; Prednisolone; Quinolines; Sulfides

Topics: Androstadienes; Churg-Strauss Syndrome; Dermatologic Agents; Fluticasone; Humans

Topics: Acetates; Adult; Androstadienes; Asthma; Churg-Strauss Syndrome; Cyclopropanes; Diagnosis, Differential; Diarrhea; Fluticasone; Glucocorticoids; Heart Failure; Humans; Leukotriene Antagonists; Lung; Male; Muscle Hypotonia; Prednisone; Quinolines; Radiography; Sulfides