A case of churg-strauss syndrome: evidence of eosinophilic vasculitis on liver biopsy

Purpose: Churg-Strauss syndrome (CSS) is a rare disease characterized by pulmonary and systemic small vessel necrotizing vasculitis and peripheral blood eosinophilia occurring in asthmatics. Cases of CSS with hepatic involvement have been rarely reported. Here, we reported a case of CSS involving liver, in which liver biopsy revealed eosinophilic vasculitis. Methods: A 75-year-old man complained of dyspnea and hemoptysis. He had severe blood eosinophilia (white blood cell 28,320/mu L, eosinophils 79%). Computed tomography of chest and abdomen showed infiltrations in lungs and multifocal infiltrations in both hepatic lobes. Methacholine PC20 was 2.89 mg/mL, which was in asthmatic range. Results: Ultrasonography-guided liver biopsy was performed, showing eosinophilic vasculitis and portal granulomas. CSS can be diagnosed based on evidence of asthma, blood eosinophilia, pulmonary infiltration and vasculitis on biopsy. Conclusion: Taken together, in a suspected case of CSS presenting as hepatic involvement, liver biopsy may be useful to demonstrate the presence of vasculitis.