—  SPECIALTY CONFERENCE  —

Dermatopathology

Case 8 - Churg-Strauss-Like Syndrome Related to Montelukast Therapy

James W. Patterson
University of Virginia Health Sciences Center
Charlottesville, VA


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Clinical History
A 46 year old woman had a two week history of tender, erythematous papules and nodules on the hands, arms, and legs. She did not have fever, chills, or systemic symptoms, and there was a negative history for arthritis. A medication history was obtained. The clinician's differential diagnosis included erythema elevatum diutinum, erythema nodosum, and "lymphocytic infiltration". Biopsy from lesion on the left arm of a 46 year old woman


Case 8 - Figure 1 -
At low power, there is a moderately dense dermal infiltrate with angiocentricity.
Case 8 - Figure 2 -
The infiltrate has perivascular and interstitial components. Granulomatous inflammation can be identified.



Case 8 - Figure 3 -
Lymphocytes and granulomatous elements predominate, but a few granulocytes can also be identified. Both neutrophils and eosinophils were seen on high power.
Case 8 - Figure 4 -
Endothelial swelling and permeation of vessel walls by inflammatory cells indicate a degree of vasculitis. Some areas are suggestive of "granulomatous vasculitis".


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References

  1. English J, 3rd, Greer KE, McCrone SA, Patterson JW, VanLoock JS. Fluticasone-associated cutaneous allergic granulomatous vasculitis. J Drugs Dermatol 2003;2(3):326-329.

  2. Cooper SM, Libman BS, Lazarovich M. Churg-strauss syndrome in a group of patients receiving fluticasone for asthma. J Rheumatol 2002;29(12):2651-2652.

  3. Conen D, Leuppi J, Bubendorf L, Ronsdorf A, Tamm M, Hauser T. Montelukast and Churg-Strauss syndrome. Swiss Med Wkly 2004;134(25-26):377-380.

  4. Tuggey JM, Hosker HS. Churg-Strauss syndrome associated with montelukast therapy. Thorax 2000 ;55(9):805-806.

  5. Wechsler ME, Finn D, Gunawardena D, Westlake R, Barker A, Haranath SP, et al. Churg-Strauss syndrome in patients receiving montelukast as treatment for asthma. Chest 2000;117(3):708-713.