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Churg-Strauss Syndrome as an Unusual Cause of Dysphagia: Case Report.

Park J, Im S, Moon SJ, Park GY, Jang Y, Kim Y - Ann Rehabil Med (2015)

Bottom Line: Biopsy of the nasal cavity showed extravascular eosinophilic infiltration.All these findings suggested a rare form of Churg-Strauss syndrome involving multiple lower cranial nerves.Dysphagia improved after steroid therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea.

ABSTRACT
Systemic vasculitis is a rare disease, and the diagnosis is very difficult when patient shows atypical symptoms. We experienced an unusual case of dysphagia caused by Churg-Strauss syndrome with lower cranial nerve involvement. A 74-year-old man, with a past history of sinusitis, asthma, and hearing deficiency, was admitted to our department for evaluation of dysphagia. He also complained of recurrent bleeding of nasal cavities and esophagus. Brain magnetic resonance imaging did not show definite abnormality, and electrophysiologic findings were suggestive of mononeuritis multiplex. Dysphagia had not improved after conventional therapy. Biopsy of the nasal cavity showed extravascular eosinophilic infiltration. All these findings suggested a rare form of Churg-Strauss syndrome involving multiple lower cranial nerves. Dysphagia improved after steroid therapy.

No MeSH data available.


Related in: MedlinePlus

Results of magnetic resonance imaging (MRI) and computed tomography (CT). T2-weighted brain MRI (A, B) in the axial view show no acute lesion or neurodegenerative change. Chest CT (C) in the axial view showed small centrilobular nodules in right upper lobe posterior segment and multifocal bronchiolitis in bilateral upper and lower lobes. Paranasal sinus CT (D) in coronal section showed mucosal thickening (asterisks) in bilateral maxillary sinuses.
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Figure 2: Results of magnetic resonance imaging (MRI) and computed tomography (CT). T2-weighted brain MRI (A, B) in the axial view show no acute lesion or neurodegenerative change. Chest CT (C) in the axial view showed small centrilobular nodules in right upper lobe posterior segment and multifocal bronchiolitis in bilateral upper and lower lobes. Paranasal sinus CT (D) in coronal section showed mucosal thickening (asterisks) in bilateral maxillary sinuses.

Mentions: Laboratory studies on admission were nonspecific, except for mild anemia (hemoglobin 9.3 g/dL, hematocrit 29.2%) and mild eosinophilia (5.3%). Serology tests for HLA-B51 and ANCA were negative. An endoscopy detected multiple esophageal ulcers (Fig. 1). Brain magnetic resonance imaging showed no definite brain lesion that might correlate with patient's dysphagia (Fig. 2A, 2B). Chest computed tomography showed focal aspiration pneumonia in right lower lobe, small centrilobular nodules in right upper lobe, and multifocal bronchiolitis in bilateral upper and lower lobes (Fig. 2C). Paranasal sinus computed tomography showed chronic sinusitis in bilateral maxillary sinuses (Fig. 2D). The pure tone average test for evaluation of hearing deficiency implied sensorineural hearing loss. Brainstem auditory evoked potential was not evoked in bilateral sides. Results of nerve conduction study and needle electromyography (EMG) were suggestive of peripheral sensory-motor polyneuropathy of mononeuritis multiplex type (Table 1).


Churg-Strauss Syndrome as an Unusual Cause of Dysphagia: Case Report.

Park J, Im S, Moon SJ, Park GY, Jang Y, Kim Y - Ann Rehabil Med (2015)

Results of magnetic resonance imaging (MRI) and computed tomography (CT). T2-weighted brain MRI (A, B) in the axial view show no acute lesion or neurodegenerative change. Chest CT (C) in the axial view showed small centrilobular nodules in right upper lobe posterior segment and multifocal bronchiolitis in bilateral upper and lower lobes. Paranasal sinus CT (D) in coronal section showed mucosal thickening (asterisks) in bilateral maxillary sinuses.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496520&req=5

Figure 2: Results of magnetic resonance imaging (MRI) and computed tomography (CT). T2-weighted brain MRI (A, B) in the axial view show no acute lesion or neurodegenerative change. Chest CT (C) in the axial view showed small centrilobular nodules in right upper lobe posterior segment and multifocal bronchiolitis in bilateral upper and lower lobes. Paranasal sinus CT (D) in coronal section showed mucosal thickening (asterisks) in bilateral maxillary sinuses.
Mentions: Laboratory studies on admission were nonspecific, except for mild anemia (hemoglobin 9.3 g/dL, hematocrit 29.2%) and mild eosinophilia (5.3%). Serology tests for HLA-B51 and ANCA were negative. An endoscopy detected multiple esophageal ulcers (Fig. 1). Brain magnetic resonance imaging showed no definite brain lesion that might correlate with patient's dysphagia (Fig. 2A, 2B). Chest computed tomography showed focal aspiration pneumonia in right lower lobe, small centrilobular nodules in right upper lobe, and multifocal bronchiolitis in bilateral upper and lower lobes (Fig. 2C). Paranasal sinus computed tomography showed chronic sinusitis in bilateral maxillary sinuses (Fig. 2D). The pure tone average test for evaluation of hearing deficiency implied sensorineural hearing loss. Brainstem auditory evoked potential was not evoked in bilateral sides. Results of nerve conduction study and needle electromyography (EMG) were suggestive of peripheral sensory-motor polyneuropathy of mononeuritis multiplex type (Table 1).

Bottom Line: Biopsy of the nasal cavity showed extravascular eosinophilic infiltration.All these findings suggested a rare form of Churg-Strauss syndrome involving multiple lower cranial nerves.Dysphagia improved after steroid therapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea.

ABSTRACT
Systemic vasculitis is a rare disease, and the diagnosis is very difficult when patient shows atypical symptoms. We experienced an unusual case of dysphagia caused by Churg-Strauss syndrome with lower cranial nerve involvement. A 74-year-old man, with a past history of sinusitis, asthma, and hearing deficiency, was admitted to our department for evaluation of dysphagia. He also complained of recurrent bleeding of nasal cavities and esophagus. Brain magnetic resonance imaging did not show definite abnormality, and electrophysiologic findings were suggestive of mononeuritis multiplex. Dysphagia had not improved after conventional therapy. Biopsy of the nasal cavity showed extravascular eosinophilic infiltration. All these findings suggested a rare form of Churg-Strauss syndrome involving multiple lower cranial nerves. Dysphagia improved after steroid therapy.

No MeSH data available.


Related in: MedlinePlus