[Ulcerative colitis as a primary manifestation of Churg-Strauss syndrome]

A 29-year-old woman with chronic bronchial asthma and inflammatory bowel disease, previously classified as idiopathic, was hospitalized because of bouts of fever and increasing dyspnoea and diarrhoea. Chest radiograph showed extensive bilateral pulmonary infiltrates. Thought to be suffering from bacterial pneumonia she was treated with broad-spectrum antibiotic, but without improvement even after a change of antibiotics. Numerous diagnostic tests failed to find any causative organism. Subsequently she was found to have peripheral eosinophilia and pericardial effusion associated with echocardiographic and electrocardiographic signs of myocarditis, which raised the suspicion of allergic granulomatous vasculitis (Churg-Strauss syndrome). The patient's acute illness contraindicated a lung biopsy, but the clinical picture left no doubt of the true diagnosis. Treatment with methylprednisolone (initially 250 mg, then 80 mg daily) rapidly improved the clinical, radiological and biochemical findings. But four months later, under maintenance treatment with 15 mg methylprednisolone daily, she experienced another bout of colitis and, a few days later, pulmonary recurrence of the Churg-Strauss syndrome, both clinically and radiologically. The dose of methylprednisolone was raised to 60 mg daily. The inflammatory bowel disease, endoscopically manifesting as ulcerative colitis, was most likely part of the systemic vasculitis.-This case demonstrates that colitis can be the primary manifestation of Churg-Strauss syndrome.