A Case Study of Churg Strauss Syndrome with Montelukast and Inhaled Corticosteroids

Abstract

RATIONALE: Is Churg Strauss Syndrome occurring in asthmatics on leukotriene inhibitors due to the leukotriene inhibitor itself or to a reduction of oral or high dose inhaled corticosteroids? METHODS: This is a case study of Churg Strauss occurring in a patient who was on neither oral nor high dose inhaled corticosteroids RESULTS: A 47-year-old woman with mild persistent asthma,allergic rhinitis, sinusitis, and nasal polyps presented with malaise, arthralgias, dyspnea, orthopnea, and cough. She had two pneumonias diagnosed by chest x-rays within 2 months of starting montelukast. The patient had been started on montelukast in an attempt to enhance control of her nasal polyps. Prior to montelukast she had used Fluticasone 44-110 2 inhalations BID. While ill she had a white blood count of 18,000 with 50% eosinophils, and normal sedimentation rate. Her EKG showed a new right bundle branch block and a chest x-ray had bilateral lower lobe infiltrates and small effusions. She was eventually diagnosed with Churg-Strauss Syndrome after an extensive work-up. There have been several case reports where Churg-Strauss Syndrome was associated with leukotriene receptor antagonists. In most cases the patients had been on systemic steroids or inhaled corticosteroids which were then tapered. This suggests that the steroids were suppressing the syndrome. CONCLUSIONS: There are very few cases, like this case, in which patients were on a stable dose of inhaled corticosteroids, montelukast therapy was begun, and still the patients developed Churg-Strauss Syndrome. This again opens the possibility that there may be a cause and effect link between montelukast and Churg-Strauss Syndrome.