CHURG-STRAUSS-SYNDROME WITH A MASS IN THE RIGHT VENTRICLE

History and clinical findings: A 47-year-old woman was admitted becaus e of diarrhoea (3-5 stools daily) for 9 days, weakness for 3 weeks and painful wrist swelling, arthralgia and hypaesthesia over the medial a spect of the right thigh for 6 weeks. For 6 years she had been treated for asthma. Two operation had been performed for chronic sinusitis. A dmission findings and investigations: There was marked eosinophilia (5 889/mu l) and thrombocytopenia (96 000/mu l), markedly increased serol ogical inflammatory parameters and a raised total IgE level (134 IU/ml ). The chest radiogram; showed pulmonara infiltrates and bone marrow b iopsy indicated eosinophilia. Echocardiography revealed a mass, 3 x 8 cm, in the ventral wall of the right ventricle with extension into the outflow tract. Diagnosis, treatment and course: These findings met th e criteria of the American College of Rheumatology. for Churg-Strauss syndrome (CSS). On methylprednisolone (1 mg/kg daily) the eosinophil a nd platelet counts became normal within 5 days and erythrocyte sedimen tation rate and the level of C-reactive protein fell. Under cardiopulm onary bypass the tumour was removed, the tricuspid valve replaced, and the right ventricle reconstructed. Histology of the mass revealed it to be an organized thrombus. Conclusion: The relationship between the thrombus formation and CSS is unclear. Hypercoagulability connected wi th the inflammatory process may have played a part In the pathogenesis .