CHURG-STRAUSS-SYNDROME (ALLERGIC GRANULOMATOUS ANTIITIS) WITH MULTIPLE PERFORATING ULCERS OF THE SMALL-INTESTINE, MULTIPLE ULCERS OF THE COLON, AND MONONEURITIS MULTIPLEX

A case of Churg-Strauss syndrome with multiple perforations of the sma ll intestine is described. A 31-year-old woman was admitted with a com plaint of epigastric pain. She had a history of bronchial asthma. One week before admission, white blood cell count was 20 800/mm(3) with 59 % eosinophils. Neurological examination on admission disclosed mononeu ritis multiplex with paresthesia in both the lower and upper extremiti es. At colonoscopy, there were scattered aphthous ulcers in the colon. Ophthalmological examination revealed allergic conjunctivitis. After admission, hypereosinophilia increased to as high as 36 000/mm(3). Ora l administration of prednisolone (60 mg/day) was begun. On the 3rd day of the treatment, the eosinophil count decreased dramatically, to 400 /mm(3), while severe abdominal pain developed. Since abdominal X-ray h im revealed free air in the abdominal cavity, emergency laparotomy was performed and multiple intestinal ulcers with perforations were found . Partial ileectomy was performed. Pathological findings of the resect ed specimen were interpreted as a necrotizing angiitis with extravascu lar granuloma. Since the operation, the patient has been asymptomatic, except for neurological symptoms. Hypereosinophilia has decreased wit hout treatment to counts averaging 270/mm(3), within 3 months. On the basis of the clinical features and histopathological findings, a diagn osis of Churg-Strauss syndrome was established.