[Allergic granulomatous angitis with hyper expression of eosinophilic adhesion molecules]

A 43-year-old man who had been treated for bronchial asthma presented with an increase in dry coughing and wheezing for one and a half years. In August 1994, the patient noted progressive dyspnea on exertion. A chest radiograph revealed nodular opacity in the right upper lung field. In November 1994, the patient was admitted to Kinki University Hospital with an erythematous rash on the soles of both feet. Examination of a specimen biopsy of the skin lesion revealed granuloma with eosinophil infiltration. Peripheral blood eosinohilia was noted and a bone marrow examination also revealed an increased level of eosinophils. Another chest radiograph revedaled that the nodular opacity had disappeared and a new bilateral pleural effusion was seen. Eosinophils were the predominant cells in the pleural effusion. the patient's condition was further complicated by myocarditis. Allergic granulomatous angitis (Churg-Strauss syndrome) was diagnosed and steroid therapy was started. After the start of steroid therapy, the skin eruption disappered and the myocarditis became less severe. Symptoms of asthma were also well controlled. The eosinophils had hypersegmented unclei and increased expression of adhesion molecules on their surfaces.