Although pleural efiiisions are present in 29 percent of Churg-Strauss patients, these effusions tend to be small and manifest only as occasional pleurisy. There are only two reported cases in which pleural fluid has been examined in Churg-Strauss syndrome, and neither of these reports comment on pleural fluid pH or chemistries. In this case of Churg-Strauss syndrome, two separate thoracocenteses show these efiiisions to be acidotic exudates with marked eosinophilia and markedly low glucose. The differential diagnosis of acidotic pleural efiiisions with low glucose is limited to esophageal rupture, infection, malignancy, and rheumatoid efiiisions. review
In this case, these causes were excluded by the results of pleural and open lung biopsies and by negative cultures of pleural fluid, pleura, and lung tissue. Rheumatoid efiiisions may rarely present before manifestations of joint disease, and rheumatoid arthritis patients may have peripheral eosinophilia. Also, there are case reports of eosinophilic pleural efiiisions in rheumatoid disease. However, these patients had between 2 and 31 percent eosinophils in their pleural fluid. In addition, all of these patients had rheumatoid skin nodules and most had joint disease and rheumatoid pleural nodules. The patient we describe lacked any joint, skin, pleural, or lung parenchymal evidence of rheumatoid arthritis. The increased rheumatoid factor in our patient is nonspecific and has been described in 52 percent of patients with Churg-Strauss syndrome.
There have been several reviews of eosinophilic pleural effusions. Most reviews stress that eosinophilic efiiisions are rarely associated with malignancy and usually indicate a “benign“ course. Conspicuously absent from all lists is Churg-Strauss syndrome, despite the common occurrence of efiiisions with this disease. This case describes the cellular and biochemical characteristics of the pleural effusions in a case of Churg-Strauss syndrome. The differential diagnosis of acidotic exudative pleural efiiisions with low glucose should include Churg-Strauss syndrome.