DOI QR코드

DOI QR Code

Clinical features and prognostic factors of Churg-Strauss syndrome

  • Kim, Mi-Yeong (Department of Internal Medicine, Inje University Busan Paik Hospital) ;
  • Sohn, Kyoung-Hee (Department of Internal Medicine, Seoul National University Hospital) ;
  • Song, Woo-Jung (Department of Internal Medicine, Seoul National University Hospital) ;
  • Park, Heung-Woo (Department of Internal Medicine, Seoul National University Hospital) ;
  • Cho, Sang-Heon (Department of Internal Medicine, Seoul National University Hospital) ;
  • Min, Kyung-Up (Department of Internal Medicine, Seoul National University Hospital) ;
  • Kang, Hye-Ryun (Department of Internal Medicine, Seoul National University Hospital)
  • Received : 2013.01.22
  • Accepted : 2013.07.10
  • Published : 2014.01.01

Abstract

Background/Aims: Churg-Strauss syndrome (CSS) is a rare systemic necrotizing small-vessel vasculitis, with accompanying bronchial asthma, eosinophilia, and eosinophilic infiltration of various tissues. The purposes of our study were to characterize the clinical features of CSS and to identify factors associated with CSS prognosis in Koreans. Methods: Medical records were reviewed retrospectively for all physician-diagnosed CSS patients in the Seoul National University Hospital between January 1990 and March 2011. Results: Data from 52 CSS patients were analyzed. The respiratory tract was the most commonly involved organ (90.4%). Renal involvement was less frequent in antineutrophilic cytoplasmic antibody (ANCA)(-) patients than in ANCA(+) patients (p = 0.048). Clinical remission occurred in 95.3% of patients, but 16.3% of them relapsed. Patients who maintained remission for more than 6 months were relatively older (median, 51 years) at diagnosis (p = 0.004), had been diagnosed in earlier stages (p = 0.027), showed more frequent respiratory involvement (p = 0.024) and generalized symptoms (p = 0.039), and showed less frequent cutaneous involvement (p = 0.030) than those who did not achieve persistent (> 6 months) remission. Patients who achieved persistent remission also showed higher C-reactive protein (CRP) levels (p = 0.031) than those who did not. Conclusions: ANCA(-) CSS patients showed less frequent renal involvement. Characteristics of good responders were older age, diagnosis at earlier stages, less cutaneous involvement, more respiratory involvement, high CRP values, and more generalized symptoms.

Keywords

References

  1. Noth I, Strek ME, Leff AR. Churg-Strauss syndrome. Lancet 2003;361:587-594. https://doi.org/10.1016/S0140-6736(03)12518-4
  2. Churg J, Strauss L. Allergic granulomatosis, allergic angiitis, and periarteritis nodosa. Am J Pathol 1951;27:277-301.
  3. Guillevin L, Cohen P, Gayraud M, Lhote F, Jarrousse B, Casassus P. Churg-Strauss syndrome: clinical study and long-term follow-up of 96 patients. Medicine (Baltimore) 1999;78:26-37. https://doi.org/10.1097/00005792-199901000-00003
  4. Dunogue B, Pagnoux C, Guillevin L. Churg-strauss syndrome: clinical symptoms, complementary investigations, prognosis and outcome, and treatment. Semin Respir Crit Care Med 2011;32:298-309. https://doi.org/10.1055/s-0031-1279826
  5. Szczeklik W, Jakiela B, Adamek D, Musial J. Cutting edge issues in the Churg-Strauss syndrome. Clin Rev Allergy Immunol 2013;44:39-50. https://doi.org/10.1007/s12016-011-8266-y
  6. Sable-Fourtassou R, Cohen P, Mahr A, et al. Antineutrophil cytoplasmic antibodies and the Churg-Strauss syndrome. Ann Intern Med 2005;143:632-638. https://doi.org/10.7326/0003-4819-143-9-200511010-00006
  7. Sinico RA, Di Toma L, Maggiore U, et al. Prevalence and clinical significance of antineutrophil cytoplasmic antibodies in Churg-Strauss syndrome. Arthritis Rheum 2005;52:2926-2935. https://doi.org/10.1002/art.21250
  8. Baldini C, Talarico R, Della Rossa A, Bombardieri S. Clinical manifestations and treatment of Churg-Strauss syndrome. Rheum Dis Clin North Am 2010;36:527-543. https://doi.org/10.1016/j.rdc.2010.05.003
  9. Choi JH, Ahn IS, Lee HB, Park CW, Lee CH, Ahn HK. A case of churg-strauss syndrome. Ann Dermatol 2009;21:213-216. https://doi.org/10.5021/ad.2009.21.2.213
  10. Kim KM. An atypical case of Churg-Strauss syndrome without asthma. Korean J Med 2009;77:659-664.
  11. Kim HW, Song YW, Chang SH, et al. A case of Churg-Strauss syndrome with endomyocardial fibrosis. J Korean Rheum Assoc 2010;17:306-310. https://doi.org/10.4078/jkra.2010.17.3.306
  12. Lee CH, Song JH, Jang SJ, Han YJ, Lee MS. A case of recurrent bowel perforation in a patient with Churg-Strauss syndrome. J Korean Rheum Assoc 2010;17:326-330. https://doi.org/10.4078/jkra.2010.17.3.326
  13. Lee SB, Kang HC, Choi JJ. A case report of anti-neutrophil cytoplasmic antibodies negative Churg-Strauss syndrome. Korean J Fam Med 2010;31:308-313. https://doi.org/10.4082/kjfm.2010.31.4.308
  14. Na SY, Jeon SY, Kim YJ, et al. A case of Churg-Strauss syndrome with diffuse trachea-bronchial involvement and left ventricular thrombus. Korean J Asthma Allergy Clin Immunol 2010;30:314-319.
  15. Chung S, Lee JH, Jeon JS, et al. A case of Churg-Strauss syndrome complicated by deep vein thrombosis. Korean J Asthma Allergy Clin Immunol 2011;31:148-152.
  16. Kim TW, Song M, Park HJ, et al. Three cases of Churg-Strauss syndrome diagnosed after presence of cutaneous manifestation. Korean J Dermatol 2011;49:62-67.
  17. Lim YH, Lee SP, Koh EM, Choi DC. Effect of intravenous pulse cyclophosphamide in the treatment of Churg-Strauss syndrome with refractory neuropathy to high-dose steroid treatment. J Asthma Allergy Clin Immunol 2000;20:113-121.
  18. Seok JI, Bae JS, Joo EY, Min TH, Choi DC, Kim BJ. Clinical and electrophysiologic features of peripheral neuropathy in Churg-Strauss syndrome. J Korean Neurol Assoc 2004;22:127-133.
  19. Oh MJ, Lee JY, Kwon NH, Choi DC. Churg-Strauss syndrome: the clinical features and long-term follow-up of 17 patients. J Korean Med Sci 2006;21:265-271. https://doi.org/10.3346/jkms.2006.21.2.265
  20. Adinoff AD, Rosloniec DM, McCall LL, Nelson HS. Immediate skin test reactivity to Food and Drug Administration-approved standardized extracts. J Allergy Clin Immunol 1990;86:766-774. https://doi.org/10.1016/S0091-6749(05)80181-2
  21. Nakano H, Ozaki S. Review article: antineutrophil cytoplasmic antibody in small vessel vasculitis. Rinsho Byori 2010;58:480-489.
  22. Gross WL, Schmitt WH, Csernok E. ANCA and associated diseases: immunodiagnostic and pathogenetic aspects. Clin Exp Immunol 1993;91:1-12.
  23. Masi AT, Hunder GG, Lie JT, et al. The American College of Rheumatology 1990 criteria for the classification of Churg-Strauss syndrome (allergic granulomatosis and angiitis). Arthritis Rheum 1990;33:1094-1100.
  24. Falk RJ, Terrell RS, Charles LA, Jennette JC. Anti-neutrophil cytoplasmic autoantibodies induce neutrophils to degranulate and produce oxygen radicals in vitro. Proc Natl Acad Sci U S A 1990;87:4115-4119. https://doi.org/10.1073/pnas.87.11.4115
  25. Heeringa P, Brouwer E, Tervaert JW, Weening JJ, Kallenberg CG. Animal models of anti-neutrophil cytoplasmic antibody associated vasculitis. Kidney Int 1998;53:253-263. https://doi.org/10.1046/j.1523-1755.1998.00743.x
  26. Xiao H, Heeringa P, Hu P, et al. Antineutrophil cytoplasmic autoantibodies specific for myeloperoxidase cause glomerulonephritis and vasculitis in mice. J Clin Invest 2002;110:955-963. https://doi.org/10.1172/JCI0215918
  27. Bourgarit A, Le Toumelin P, Pagnoux C, et al. Deaths occurring during the first year after treatment onset for polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss syndrome: a retrospective analysis of causes and factors predictive of mortality based on 595 patients. Medicine (Baltimore) 2005;84:323-330. https://doi.org/10.1097/01.md.0000180793.80212.17
  28. Phillip R, Luqmani R. Mortality in systemic vasculitis: a systematic review. Clin Exp Rheumatol 2008;26(5 Suppl 51):S94-S104.
  29. Guillevin L. Advances in the treatments of systemic vasculitides. Clin Rev Allergy Immunol 2008;35:72-78. https://doi.org/10.1007/s12016-007-8068-4
  30. Guillevin L, Pagnoux C, Seror R, Mahr A, Mouthon L, Le Toumelin P. The Five-Factor Score revisited: assessment of prognoses of systemic necrotizing vasculitides based on the French Vasculitis Study Group (FVSG) cohort. Medicine (Baltimore) 2011;90:19-27. https://doi.org/10.1097/MD.0b013e318205a4c6

Cited by

  1. A 43-year-old patient presenting with marked eosinophilia and multisystem disease vol.12, pp.3, 2016, https://doi.org/10.1183/20734735.009016
  2. Optimal therapy and prospects for new medicines in eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) vol.12, pp.10, 2014, https://doi.org/10.1080/1744666x.2016.1191352
  3. Cutaneous manifestations of Churg-Strauss syndrome: key to diagnosis vol.92, pp.5, 2014, https://doi.org/10.1590/abd1806-4841.20175522
  4. Clinical Characteristics and Treatment Response of Peripheral Neuropathy in the Presence of Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss Syndrome): Experience at a Single Tertiary Cent vol.13, pp.1, 2014, https://doi.org/10.3988/jcn.2017.13.1.77
  5. Antineutrophil Cytoplasmic Antibody-Associated Vasculitis in Korea: A Narrative Review vol.60, pp.1, 2014, https://doi.org/10.3349/ymj.2019.60.1.10
  6. CHURG-STRAUSS SYNDROME: CLINICAL CASE AND ITS FEAUTURES vol.72, pp.4, 2014, https://doi.org/10.36740/wlek201904142
  7. Eosinophilic Granulomatosis with Polyangiitis: Experiences in Korean Patients vol.60, pp.8, 2014, https://doi.org/10.3349/ymj.2019.60.8.705
  8. Evaluation and Management of Difficult-to-Treat and Severe Asthma: An Expert Opinion From the Korean Academy of Asthma, Allergy and Clinical Immunology, the Working Group on Severe Asthma vol.12, pp.6, 2014, https://doi.org/10.4168/aair.2020.12.6.910
  9. Clinical Manifestations and Long‐Term Outcomes of Eosinophilic Granulomatosis With Polyangiitis in North America vol.3, pp.6, 2014, https://doi.org/10.1002/acr2.11263