CHURG-STRAUSS-SYNDROME (ALLERGIC GRANULOMATOUS ANGITIS) PRESENTING WITH ILEUS CAUSED BY ISCHEMIC ILEAL ULCER

We report a rare case of Churg-Strauss syndrome (CSS) in a 41-year-old Japanese man with a history of middle-age onset of bronchial asthma w ho had severe abdominal pain. He presented with ileus caused by an ann ular ulcer of the ileum, attributable to mucosal ischemia resulting fr om necrotizing vasculitis of the mesenteric artery. He also had marked hypereosinophilia (51.5%), elevated serum IgE levels (34 040 IU/ml), and generalized enlargement of the superficial cervical lymph nodes. c ontaining eosinophilic granulomas. A stenotic lesion caused by an annu lar ulcer in the ileum was found and resected by laparotomy. Microscop ic examination of the resected specimen revealed luminal narrowing or occlusion of small arteries in the ulcer base, subserosa, and mesenter ium resulting from marked fibrotic intimal thickening with fragmentati on or lack of the internal elastic lamina. These findings were diagnos ed as vasculitis, scar stage. The postoperative course was uneventful, with the patient receiving a maintenance dose of prednisolone (10-15 mg/day) for 7 years subsequently. We must carefully diagnose and treat patients with middle-age onset asthma, because the symptom may be a l ung manifestation of CSS, in which various organs including gastrointe stinal tract are involved as a result of systemic necrotizing vasculit is.