Churg Strauss syndrome with rare manifestations

Introduction:Churg Strauss syndrome (CSS) is rare systemic disease characterized by asthma, hypereosinophilia and vasculitis. Although it can affect any organ, lung is frequently involved and cases of CSS with hepatic involvement have been rarely reported.Case report: 37-year-old female presented with polyarthralgia, hypostasis in both hands, skin lesions on body that appeared as blisters with pruritus and past medical history of asthma. Lab tests revealed elevated ESR and CRP. Serum tests were negative for ANA, dsDNA, RF, CCP, HBSAg, HCVAb, and AntiHIV and LDH level was reported normal and also tests for wright, coombs, and 2ME was negative too. After months the patient was referred to rheumatologist. For further evaluation CBCdiff was asked. Leukocytes count was 13000 with 20% Eosinophil and normal Hb. ANCA, c-ANCA and p-ANCA was reported negative. Both lung CT and liver CT showed Multiple nodules. Upper and lower GI endoscopy appeared normal. For malignancy workup Bone marrow Aspiration and Biopsy was taken that was normal too. In the biopsy of skin lesion, Eosinophilic Vasculitis was seen. EMG and NCV was compatible to C8-T11 radiculopathy and Axonal Sensory motor Polyneuropathy. According to the tests and biopsies the patient was diagnosed with Churg Strauss Syndrome and underwent its related treatment.Conclusion: This syndrome causes variety of presentations. Here, we reported case of CSS involving skin, lung, nervous system, joint and liver which some of them are not common among patients. It is important to recognize that uncommon organs like liver maybe involved in CSS.