Internal Medicine

0521779407-C02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

Chronic Respiratory Failure Churg Strauss Disease 357

complications and prognosis

■Nosocomial pneumonia

■Permanent ventilator dependence

Churg Strauss Disease.................................

ERIC L. MATTESON, MD

history & physical

■Similar to Wegener’s, with asthma;

■GI complaints more common, renal disease less so

tests

Laboratory

■CBC for anemia, thrombocytosis, (eosinophilia in CS)

■ESR and/or C-reactive protein elevated

■Urinalysis

■Anti-neutrophil anti-cytoplasmic antibody (c-ANCA) positive in

>90% of patients with WG and many with CS

Other Tests

■Biopsy

➣GCA: Temporal artery shows mononuclear cell infiltration and

multinucleated giant cells, intimal proliferation. Histology in TA

is similar.

➣WG, CS: Non-caseating granuloma, vasculitis in mucosal, der-

mal, retroocular, pulmonary lesions; rapidly progressive or focal

segmental glomerulonephritis in kidney

■Imaging

➣Chest radiography and CT: Pulmonary nodules, pleural effusions

in WG; fleeting infiltrates more common in CS

➣Arteriogram required for diagnosis and follow-up of TA, may be

needed in GCA for symptomatic stenosis

➣Echocardiography in TA or GCA may reveal aortic aneurysm

differential diagnosis

■GCA, TA

➣Migraine, especially ophthalmoplegic migraine

➣Cluster headache

➣Viral syndromes

➣Polymyalgia rheumatica in patients >50 years of age