Internal Medicine

0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:11

648 Granulomatous Vasculitis

Churg-Strauss Disease (CS)

■Similar to Wegener’s, w/ asthma

■History of atopy, allergic rhinitis

■After 5-lipoxygenase inhibitors in asthma

■GI complaints more common, renal disease less so

tests

Lab Tests

■CBC for anemia, thrombocytosis (marked eosinophilia in CS

1,000/mm^3 )

■ESR and/or C-reactive protein elevated

■Urinalysis

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

>90% of pts w/ WG & many w/ CS

Other Tests

■Biopsy

➣GCA: Temporal artery shows mononuclear cell infiltration &

multinucleated giant cells, intimal proliferation. Histology in TA

is similar.

➣WG, CS: noncaseating granuloma, vasculitis in mucosal, dermal,

retroocular, pulmonary lesions; rapidly progressive or focal seg-

mental glomerulonephritis in kidney

Imaging

■Chest radiography & CT: pulmonary nodules, pleural effusions in

WG; fleeting infiltrates more common in CS

■Arteriogram required for diagnosis & 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 yrs of age

➣Occult infection or malignancy

➣Myocardial ischemia