Rheumatology Medical News about Churg Strauss syndrome, Gastrointestinal, Vasculitis

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Churg-Strauss syndrome presenting as acute abdomen: Are gastrointestinal manifestations an indicator of poor prognosis?
International Journal of Rheumatic Diseases, 07/24/09

Singh R et al. – Churg-Strauss syndrome (CSS)is a rare syndrome of vasculitis of small to medium vessels with classic manifestations of asthma, eosinophilia and atopic sinusitis. Case presented in this study with a diagnosis after a severe gastrointestinal (GI) manifestation of hematochezia and acute abdomen requiring emergency surgery is reported.

This patient was presented with hematochezia
GI hemorrhage, either hematemesis or hematochezia or melena, is seen in approximately 18–21% of CSS patients
Although CSS pts could have endoscopic-proven GI ulcers, upper GI tract biopsies are rarely contributory
Whereas colonic biopsies may be helpful in some cases to establish a diagnosis
Vasculitis-related Gl ulcers can present as single or multiple ulcers of gastroduodenum, ileum or colon
Most of the reported cases have not been diagnosed until laparotomy or autopsy
There has also been a reported case of CMV associated with colonic ulcer in CSS

It is emphasized how at initial presentation, like this patient, all 4 ACR criteria to establish a diagnosis of CSS may not be present; however, clinicians need to have a high index of suspicion to recognize the disease early and start appropriate treatment.

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