An unusual case of prolonged and persistent cough due to eosinophilic granulomatosis with polyangiitis (Churg-Strauss Syndrome)

A case of a 52-year-old Caucasian woman, with a history of bronchial asthma and allergic rhinitis with nasal polyps, was admitted to our department after a period of about nine months of cough, dyspnea, non-fixed pulmonary infiltrates to imaging and progressive weight loss. During these months, the patient performed periodical long-term glucocorticoid therapy and antibiotics on several occasions with only partially beneficial to the symptom cough. Chronic asthma treatment was also enhanced by increasing the dose of inhaled steroid and adding cysteinyl leukotriene (CysLT 1) receptor antagonist to the therapy. Finally, antibiotic therapy with azithromycin was also performed for one month for the persistence of the cough. When she was admitted to our department, laboratory findings (including blood cultures and autoimmunity) showed a mild increase of C reactive protein (CRP), and an increased total white blood cells count with hypereosinophilia. The imaging with chest X-ray, confirmed by chest CT scan revealed diffuse bilateral consolidations in the upper lobes. Fiberoptic bronchoscopy (FBS) with bronchoalveolar lavage (BAL) fluid was negative for bacteria and fungi and showed a high number of eosinophils. The presence of asthma, peripheral blood eosinophilia, non-fixed pulmonary infiltrates, paranasal sinus abnormalities, and the BAL, revealing in the cytology the presence of hypereosinophilia, allow the diagnosis of Churg-Strauss Syndrome (CCS). The patient was treated with systemic corticosteroids, and there was a prompt clinical and radiologic improvement.