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Reminder of important clinical lesson
Churg–Strauss syndrome in a patient previously diagnosed with multiple sclerosis
  1. Pamela Sarkar,
  2. Richard Tolulope Ibitoye,
  3. Douglas Anthony Promnitz
  1. Ipswich Hospital NHS Trust, Ipswich, Suffolk, UK
  1. Correspondence to Dr Pamela Sarkar, pam524sarkar{at}hotmail.com

Summary

A lady in her 70s with a background of multiple sclerosis (MS) and late-onset asthma was admitted with a 2-week history of cough and shortness of breath, progressive right-sided weakness and functional decline. Investigation revealed eosinophilia, elevated myeloperoxidase antineutrophil cytoplasmic antibody, CT sinuses showed long-standing inflammatory changes consistent with sinonasal polyposis and MRI head showed lesions consistent with vasculitis. She then developed left-sided weakness and increased wheeze. Review of her case notes demonstrated that, the eosinophilia was long-standing, her asthma was severe and steroid-dependent, and her neurologic syndrome was atypical for MS. Intravenous methylprednisolone then cyclophosphamide were administered. She demonstrated remarkable improvement, becoming more alert, with improvement in left-sided weakness. A diagnosis of Churg–Strauss syndrome was established. She was discharged to a nursing home with outpatient rheumatology follow-up. The diagnosis of MS was revisited.

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Footnotes

  • Competing interests None.

  • Patient consent Not obtained.

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