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Clinical Cases

Churg Strauss Syndrome associated with montelukast - case report

Milena Adina Man1, Dana Alexandrescu2, Monica Pop1, Antigona Trofor3 1. Iuliu Haţieganu University of Medicine and Pharmacy, Department of Pneumology, Cluj Napoca, Romania; 2. University
1. Iuliu Haţieganu University of Medicine and Pharmacy, Department of Pneumology, Cluj Napoca, Romania; 2. University of Medicine and Pharmacy, Brasov; 3. Clinic of Pulmonary Diseases Iasi, Romania


Churg-Strauss Syndrome (allergic granulomatous angiitis) is a rare systemic and pulmonary vasculitis. We report the case of a 62 years old female, non-smoker, with a 20 years history of moderate persistent asthma treated with Salmeterol/Fluticasone 50/500 μg bid for 5 years and supplemental Montelukast in the past 5 months. The patient was admitted in our hospital with fever, malaise, sensory deficits in the lower extremities, diffuse musculoskeletal and thoracic pain. Blood eosinophil was 38% of her total WBC, thoracic computed tomography evidenced ill-defined groundglass attenuation predominantly involving the lateral segment of the middle lobe. Pulmonary infiltrates with eosinophilia can be used to define eosinophilic lung diseases. We made the differential diagnosis of eosinophilic lung disease: acute or chronic eosinophilic pneumonias, allergic bronchopulmonary aspergillosis, Löffler syndrome, Churg-Strauss syndrome, bronchocentric granulomatousis, idiopathic hypereosinophilic syndromes. Bronchoalveolar lavage showed 14.6% eosinophils. Few days after hospital admission patient experienced nausea, vomiting and diarrhea. She underwent a digestive endoscopy, which showed eosinophilic enteritis according to colon biopsy. Nasal mucosa biopsy found granulomas. Anti-neutrophil cytoplasmatic antibody (ANCA) was positive at 1:20. She displayed more than four American College of Rheumatology (ACR) criteria for Churg-Strauss Syndrome (developed while she was receiving montelukast therapy). Discontinuation of Montelukast and association of oral prednisone (1mg/kgc) induced rapid improvement of symptoms and rapid decrease of peripheric eosinophils (72 hours). This case report illustrates the importance of early diagnosis of Churg-Strauss syndrome and the possible pathogenic link between leukotriene receptor antagonist use and CSS development.

Keywords: Churg Strauss syndrome, vasculitis, hypereosinophilia, eosinophilic lung disease, montelukast

Therapeutical approach in severe exacerbation of COPD associating obstructive sleep apnoea and obesity

Ştefan Dumitrache-Rujinski, Alina Croitoru, Miron Alexandru Bogdan
Institutul de Pneumologie Marius Nasta, Bucureşti


COPD exacerbations with respiratory acidosis are difficult to manage, especially when OSA and obesity are associated. The solution is the use of noninvasive ventilation associated with oxygenotherapy in order to correct the hypercapnia, hypoxemia and respiratory acidosis and to prevent the invasive mechanical ventilation. Early respiratory rehabilitation and the use of a domiciliary ventilatory support after the acute episode could be a part of the management for these patients. We present a modality of therapeutical approach through a clinical case.

Keywords: COPD, OSA, rehabilitation, noninvasive ventilation