The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지

Acalculous cholecystitis in a patient with Churg-Strauss syndrome

Churg-Strauss 증후군 환자에서 발생한 무결석 담낭염

  • Park, Jong-Hwan (Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute) ;
  • Kang, Dae-Hwan (Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute) ;
  • Lee, Jin-Ho (Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute) ;
  • Kim, Min-Dae (Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute) ;
  • Choi, Cheol-Woong (Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute) ;
  • Kim, Hyung-Wook (Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute)
  • 박종환 (부산대학교병원 소화기내과) ;
  • 강대환 (부산대학교병원 소화기내과) ;
  • 이진호 (부산대학교병원 소화기내과) ;
  • 김민대 (부산대학교병원 소화기내과) ;
  • 최철웅 (부산대학교병원 소화기내과) ;
  • 김형욱 (부산대학교병원 소화기내과)
  • Received : 2009.08.21
  • Accepted : 2009.09.25
  • Published : 2010.10.01
⟨ Previous Next ⟩

Abstract

Churg-Strauss syndrome is an uncommon disorder characterized by asthma, hypereosinophilia, and systemic vasculitis. Gastrointestinal involvement is commonly encountered in Churg-Strauss syndrome; however, acute cholecystitis is rare, and few cases have been documented in the literature. A 22-year-old female with a history of asthma was admitted with a complaint of steady pain in the right upper abdominal quadrant. Laboratory test results showed leukocytosis with hypereosinophilia. Abdominal ultrasonography and computed tomography revealed acute cholecystitis. Her symptoms did not improve with conservative treatment, so she underwent percutaneous transhepatic gallbladder drainage. Subsequently, peripheral neuropathy, erythematous papules on the skin, and dyspnea developed. A chest computed tomography scan showed bilateral pulmonary infiltrates. A pathological examination of the skin lesion indicated necrotizing vasculitis with eosinophilic infiltrates. She was diagnosed with Churg-Strauss syndrome. She was treated with corticosteroids, and her condition improved dramatically. After the drainage catheter was removed, complications including a bile leak occurred. Consequently, a cholecystectomy was performed.

저자들은 급성 무결석성 담낭염으로 발현한 Churg-Strauss 증후군 환자를 조직 소견을 포함한 ACR 기준에 따라 진단하여 치료하였고, 증상 호전 후 담낭절제술을 시행하였는데 담낭조직에서는 호산구 침윤이나 혈관염을 찾을 수 없었던 증례를 경험하여 관련 문헌 및 최근 문헌보고와 함께 보고하는 바이다.

Keywords

References

  1. Yasuda H, Takada T, Kawarada Y, Nimura Y, Hirata K, Kimura Y, Wada K, Miura F, Hirota M, Mayumi T, Yoshida M, Nagino M, Yamashita Y, Hilvano SC, Kim SW. Unusual cases of acute cholecystitis and cholangitis: Tokyo guidelines. J Hepatobiliary Pancreat Surg 14:98-113, 2007 https://doi.org/10.1007/s00534-006-1162-9
  2. Sinico RA, Bottero P. Churg-Strauss angiitis. Best Pract Res Clin Rheumatol 23:355-366, 2009 https://doi.org/10.1016/j.berh.2009.02.004
  3. Masi AT, Hunder GG, Lie JT, Michel BA, Bloch DA, Arend WP, Calabrese LH, Edworthy SM, Fauci AS, Leavitt RY, Lightfoot RW, Mcshane DJ, Mills JA, Stevens MB, Wallace SL, Zvaifler NJ. The American College of Rheumatology 1990 criteria for the classification of Churg-Strauss syndrome (allergic granulomatosis and angiitis). Arthritis Rheum 33:1094-1100, 1990
  4. Jennette JC, Falk RJ. Small-vessel vasculitis. N Engl J Med 337:1512-1523, 1997 https://doi.org/10.1056/NEJM199711203372106
  5. Lie JT. Illustrated histopathologic classification criteria for selected vasculitis syndromes. American College of Rheumatology Subcommittee on Classification of Vasculitis. Arthritis Rheum 33:1074-1087, 1990
  6. Abril A, Calamia KT, Cohen MD. The Churg Strauss syndrome (allergic granulomatous angiitis): review and update. Semin Arthritis Rheum 33:106-114, 2003 https://doi.org/10.1016/S0049-0172(03)00083-0
  7. Mukhtyar C, Guillevin L, Cid MC, Dasgupta B, de Groot K, Gross W, Hauser T, Hellmich B, Jayne D, Kallenberg CG, Merkel PA, Raspe H, Salvarani C, Scott DG, Stegeman C, Watts R, Westman K, Witter J, Yazici H, Luqmani R. EULAR recommendations for the management of primary small and medium vessel vasculitis. Ann Rheum Dis 68:310-317, 2009 https://doi.org/10.1136/ard.2008.088096
  8. Lanham JG, Elkon KB, Pusey CD, Hughes GR. Systemic vasculitis with asthma and eosinophilia: a clinical approach to the Churg-Strauss syndrome. Medicine 63:65-81, 1984 https://doi.org/10.1097/00005792-198403000-00001
  9. Lhote F, Guillevin L. Polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss syndrome: clinical aspects and treatment. Rheum Dis Clin North Am 21:911-947, 1995
  10. Keogh KA, Specks U. Churg-Strauss syndrome: clinical presentation, antineutrophil cytoplasmic antibodies, and leukotriene receptor antagonists. Am J Med 115:284-290, 2003 https://doi.org/10.1016/S0002-9343(03)00359-0
  11. Sinico RA, Di Toma L, Maggiore U, Bottero P, Radice A, Tosoni C, Grasselli C, Pavone L, Gregorini G, Monti S, Frassi M, Vecchio F, Corace C, Venegoni E, Buzio C. Prevalence and clinical significance of antineutrophil cytoplasmic antibodies in Churg-Strauss syndrome. Arthritis Rheum 52:2926-2935, 2005 https://doi.org/10.1002/art.21250
  12. Sable-Fourtassou R, Cohen P, Mahr A, Pagnoux C, Mouthon L, Jayne D, Blockmans D, Cordier JF, Delaval P, Puechal X, Lauque D, Viallard JF, Zoulim A, Guillevin L. Antineutrophil cytoplasmic antibodies and the Churg-Strauss syndrome. Ann Intern Med 143:632-638, 2005 https://doi.org/10.7326/0003-4819-143-9-200511010-00006
  13. Kim MS, Cho YJ, Roh SH. A case of Churg-Strauss syndrome which first presented as acute cholecystitis. J Asthma Allergy Clin Immunol 28:143-147, 2008
  14. Jung SH, Kim KH, Nam SM, Park HC, Chu HK, Whang IS, Kim JH, Jun HS, Park SH, Lee SH, Kim HY. A case of Churg-Strauss syndrome with manifestations of esophageal ulcer, acute acalculous cholecystitis and ischemic colitis. Korean J Med 45:369-375, 1993
  15. Suzuki M, Nabeshima K, Miyazaki M, Yoshimura H, Tagawa S, Shiraki K. Churg-Strauss syndrome complicated by colon erosion, acalculous cholecystitis and liver abscesses. World J Gastroenterol 11:5248-5250, 2005
  16. Kikuchi Y, Ikehata N, Tajima O, Yoshizawa N, Miura S. Glomerular lesions in patients with Churg-Strauss syndrome and the anti-myeloperoxidase antibody. Clin Nephrol 55:429-435, 2001
  17. Savage CO, Harper L, Adu D. Primary systemic vasculitis. Lancet 349:553-558, 1997 https://doi.org/10.1016/S0140-6736(97)80118-3
  18. Pagnoux C, Guilpain P, Guillevin L. Churg-Strauss syndrome. Curr Opin Rheumatol 19:25-32, 2007 https://doi.org/10.1097/BOR.0b013e3280119854
  19. Guillevin L, Lhote F, Gayraud M, Cohen P, Jarrousse B, Lortholary O, Thibult N, Casassus P. Prognostic factors in polyarteritis nodosa and Churg-Strauss syndrome: a prospective study in 342 patients. Medicine 75:17-28, 1996 https://doi.org/10.1097/00005792-199601000-00003
  20. Cohen P, Pagnoux C, Mahr A, Arene JP, Mouthon L, Le Guern V, Andre MH, Gayraud M, Jayne D, Blockmans D, Cordier JF, Guillevin L. Churg-Strauss syndrome with poor-prognosis factors: a prospective multicenter trial comparing glucocorticoids and six or twelve cyclophosphamide pulses in forty-eight patients. Arthritis Rheum 57:686-693, 2007 https://doi.org/10.1002/art.22679