Lesson of the month. (1). What lies beneath the surface? Diagnosis. Churg-Strauss syndrome.

This reports describes the development of a rash in a 43-year-old man with asthma, who was admitted to the respiratory clinic with dyspnoea, leucocytosis and a productive cough. His symptoms progressed and he was admitted to the high-dependency unit for respiratory support. The incisional biopsy taken from his rash was paramount in the diagnosis of systemic vasculitis. Of equal importance was recognition of eosinophilia and pneumonitis in this young man and initiation of immunosuppressive therapy. The key message from this particular case was the importance of early diagnosis of Churg-Strauss syndrome, in which a rash is combined with marked peripheral eosinophilia and signs of respiratory distress. Early intervention will reduce the risks of morbidity and mortality in patients with this rare, life-threatening syndrome.