Churg-strauss syndrome with cholecystitis and renal involvement

A patient with bronchial asthma developed cholecystitis. Laboratory investigations revealed marked eosinophilia (6,615/mm3), an elevated anti-neutrophil cytoplasmic antibody level and renal dysfunction (blood urea nitrogen 14 mg/dl, creatinine 1.4 mg/dl). Following cholecystectomy, histopathological examination revealed a marked inflammatory cell infiltrate composed mainly of eosinophils with evidence of invasion of the wall of the gall bladder and granuloma formation of arterioles. A diagnosis of Churg-Strauss syndrome was made and she was treated with 60 mg of prednisolone per day. A renal biopsy was performed one year later in view of persistent renal dysfunction. Pathological analysis revealed a pauci-immune glomerulonephritis with interstitial changes but no crescent formation.