[A case of Churg-Strauss syndrome after corticosteroid withdrawal manifesting mononeuritis multiplex and gastrointestinal perforations].

We report a case of a 70-year-old man who developed Churg-Strauss syndrome (CSS), diagnosed by characteristic histological findings, clinical presentations of mononeuritis multiplex, and multiple small intestinal ulcers with perforations, after discontinuation of corticosteroid therapy. The patient had developed asthma at age of 45, treated with oral prednisolone (10-20 mg daily) from that time. At the age of 70 he developed pneumonia. The condition responded to antibiotics, and the corticosteroid was quickly tapered and discontinued. He was never given leukotriene receptor antagonists during the course of treatment. Approximately two weeks after discontinuation of steroid therapy, he developed severe abdominal pain and mononeuritis multiplex, confirmed by nerve conduction studies. Laboratory evaluation revealed an eosinophil count of 30,450/microliter, and P-antineutrophil cytoplasmic antibody (ANCA) was positive. An abdominal CT scan revealed free air in the abdominal cavity. Laparotomy revealed multiple small intestinal ulcers with perforations. Histologic examination of the intestine showed eosinophilic vasculitis and fibrinoid necrosis. Treatment with systemic corticosteroid (prednisolone 60 mg daily) led to a clinical improvement of neurological and gastroenterological deficits. The prednisolone dose was tapered to 20 mg daily without disease flares. Recently, there have been several reports of CSS that manifested after withdrawal of steroid therapy. CSS can be precipitated in patients with adult-onset, steroid-dependent bronchial asthma after corticosteroid withdrawal.