[A case of Churg-Strauss syndrome in which oculomotor paralysis developed]

A 74-year-old man had severe persistent asthma, poorly controlled by treatment with an inhaled steroid (beclomethasone dipropionate [BDP-CFC]), an oral steroid (prednisolone), a sustained-release theophylline preparation, and a leukotriene receptor antagonist. The oral steroid dose was tapered and discontinued because the patient achieved good control by switching to inhaled steroids (fluticasone propionate [FP-DPI]) and adding inhaled cromoglycate and an inhaled beta 2 agonist. On this regimen, the peripheral-blood eosinophil count increased significantly, followed by numbness in the right hand and right foot and left oculomotor paralysis. The patient was given a diagnosis of Churg-Strauss syndrome because his symptoms improved with re-administration of the oral steroid. This syndrome is rarely accompanied by cranial nerve paralysis, and oculomotor paralysis has been reported in only 4 Churg-Strauss patients. The clinical course of this patient was considered to be consistent with Churg-Strauss syndrome, which had been suppressed by steroids for asthma control, but then manifested with dose tapering and discontinuation of the systemic steroid therapy.