Seven cases of complete and incomplete forms of Churg-Strauss syndrome not related to leukotriene receptor antagonists

Background: Various forms of Churg-Strauss syndrome have been reported in association with the use of leukotriene receptor antagonists in asthmatic patients. Objective: Our purpose was to increase awareness that different forms of the Churg-Strauss syndrome occur in patients not receiving leukotriene modifiers. Methods: We searched for all the casts of Churg-Strauss syndrome that were seen in the University of Rochester Medical Center, New York, in the past 4 years. Results: We identified 7 patients, 6 of whom fulfilled the American College of Rheumatology criteria for the classification of Churg-Strauss syndrome, None of them used leukotriene receptor antagonists, All had asthma and sinus disease, The duration and severity of their asthma varied considerably; In the majority of the patients the features of Churg-Strauss syndrome became obvious as the systemic corticosteroid dose was being tapered or discontinued, although 3 patients had not been receiving maintenance oral corticosteroids at disease onset, Three patients had positive antineutrophil cytoplasmic antibodies test result (perinuclear pattern). There was histologic documentation of vasculitis in 4 patients, Five of 7 patients responded to high-dose corticosteroid treatment. Conclusion: Our 7 cases are similar to the various forms of Churg-Strauss syndrome that have been reported in association with the leukotriene receptor antagonists. Complete or incomplete forms of this syndrome ran become apparent in asthmatic patients as systemic corticosteroids are being tapered but ran also occur in patients with mild asthma of short duration who use only inhaled corticosteroids.