[Churg-Strauss syndrome with rectal localization and exudative enteropathy]

Area of Science:

• Gastroenterology
• Rheumatology
• Immunology

Background:

• Churg-Strauss syndrome (CSS), also known as eosinophilic granulomatosis with polyangiitis, is a rare systemic vasculitis characterized by asthma, eosinophilia, and granulomatous inflammation.
• Gastrointestinal involvement in CSS is uncommon but can present with diverse symptoms, including abdominal pain, nausea, vomiting, and diarrhea.
• Protein-losing enteropathy is a serious complication associated with gastrointestinal inflammation, leading to significant protein and albumin loss.

Observation:

• A 61-year-old patient presented with acute abdominal pain, initially masking an underlying diagnosis.
• Diagnostic investigations revealed diffuse inflammatory changes throughout the digestive tract, confirmed by endoscopy.
• Protein-losing enteropathy was identified as a complication, indicated by hypoalbuminemia and edema.
• A rectal biopsy, despite a macroscopically normal appearance of the rectum, demonstrated.

Findings:

• The patient was diagnosed with Churg-Strauss syndrome based on clinical presentation and diagnostic findings.
• The diffuse gastrointestinal involvement and protein-losing enteropathy were attributed to systemic vasculitis characteristic of CSS.
• Deep rectal biopsy confirmed the presence of vasculitis, even in areas that appeared normal to the naked eye.

Implications:

• This case highlights the importance of considering Churg-Strauss syndrome in patients presenting with unexplained gastrointestinal symptoms and inflammation.
• Early recognition and aggressive immunosuppressive therapy, including corticosteroids and cyclophosphamide, are crucial for managing life-threatening CSS manifestations.
• The findings underscore the utility of rectal biopsy in diagnosing vasculitis, even when macroscopic examination does not reveal abnormalities.