Pleural Effusion in Churg-Strauss Syndrome

14 Nov

Pleural Effusion in Churg-Strauss SyndromeChurg-Strauss syndrome is a disorder of hypereosino-philia and systemic vasculitis in subjects with asthma and allergic rhinitis. Pleural effusions are commonly reported as a manifestation of this syndrome; however, the cellular and biochemical characteristics have not been well described. In this case of Churg-Strauss syndrome, the patients pleural effusion is fully described, and the differential diagnosis of acidotic eosinophilic pleural effusions is reviewed. More info

Case Report
A 33-year-old nonsmoking man presented with a two-year history of sinusitis and progressively worsening asthma. Two weeks before admission, he developed pleurisy, first on the right and then on the left side of his chest, and a chest roentgenogram showed bilateral pleural effusions. His peripheral WBC was 34,000 cells/cu mm with 66 percent eosinophils. A thoracocentesis on the right yielded cloudy fluid with the following findings: LDH, 2856 IU/L; protein, 4.2 g/dL; pH, 7.08; glucose, less than 10 mg/dL; amylase, less than 30 U/L; RBC, 600 cells/cu mm, and WBC 10,400 cells/cu mm with a 95 percent eosinophils. Cultures for bacteria and mycobacteria were negative, and cytology was negative for malignancy. The patient was referred to National Jewish Center for Immunology and Respiratory Medicine for further evaluation.
Physical examination was unremarkable except for the lung exam, which revealed dullness at both bases and diffuse expiratory wheezing. The patient was afebrile. Blood studies revealed WBC 22,500 cells/cu mm with 62.8 percent eosinophils. Total eosinophil count was 14,130 cells/cu mm. Serum rheumatoid factor was 1:5120, serum antinuclear antibody was positive at 1:40, CH50 was 34 U/ml (normal 22-43), and C,, 113 mg/dl (normal 83 to 77). Immediate and delayed Aspergillus skin tests were negative. The PPD was negative. Examination of stool for ova and parasites was negative, and filaria and paragonia serologies were negative.