Churg-Strauss syndrome (CSS) is an uncommon disease entity first described in 1951.1 Only one previous case has documented endobronchial nodules, which were shown to be granulomas.2 The following case is the first known description of CSS presenting with both vocal cord and endobronchial nodules due to eosinophilic tissue infiltration without granulomas.
A 48-year-old male with asthma presented with hemoptysis and weight loss. Exam revealed both wheezes and crackles. His white blood cell count was 13,500/mm3 with 5,400/mm3 eosinophils. ANA and rheumatoid factor were negative and p-ANCA titer was 1:80.Computed tomography of the chest showed tracheal wall thickening, multiple pulmonary infiltrates, and scattered nodular areas of ground glass.Bronchoscopy showed multiple raised white lesions on the vocal cords, trachea, and the left and right main stem bronchi.Endobronchial biopsies revealed interstitial eosinophilia and capillaritis.Fungal cultures and acid-fast bacilli cultures were all negative. Prednisone was started; the patient noted marked improvement in his symptoms, and peripheral blood eosinophilia decreased to 1% after two days.DISCUSSION: CSS has the classical triad of allergic rhinitis, asthma, and peripheral blood eosinophilia. Approximately 10% of patients known to have one of the major vascultides has CSS. The ACR V diagnostic criteria include asthma, eosinophilia, mono- or polyneuropathy, non-fixed pulmonary “infiltrates,” paranasal sinus abnormalities, and extravascular eosinophils. Presence of four of these criteria is diagnostic of CSS with a sensitivity of 85% and specificity of 100%.CONCLUSIONS: This is an unusual case of CSS presenting with vocal cord and endobronchial nodules, highlighting the fact that the eosinophilic tissue infiltration can appear anywhere along the respiratory tract and can appear as nodular lesions on bronchoscopic visualization. CSS should be considered in the differential diagnosis of vocal cord or endobronchial nodules.
S.K. Mashour, None.