Churg-Strauss syndrome associated with montelukast therapy

Abstract

Sir, A 47-year-old woman had a 4-year history of severe asthma. Because asthma continued to deteriorate, montelukast therapy was instituted in April 2007. On September 2007, the patient presented with painful cutaneous manifestations of 1-month duration that had progressively developed, involving her elbows and hands. On admission, the patient was febrile (38°C). Physical examination revealed diffuse sibilant rales, bilaterally. Cutaneous examination demonstrated skin nodules involving her elbows and the back of her hands (Figure 1). The patient also complained of both pain and paresthesias in her lower limbs. Laboratory findings disclosed: erythrocyte sedimentation rate 34 mm/h, C-reactive protein 15 mg/l, hemoglobin 12.4 g/dl, white blood cell count 44.8 × 109/l with 55% eosinophils (calculated eosinophils were 24.6 × 109/l), platelet count: 455 × 109/l. Other routine biochemical tests, including renal and liver tests, were normal. Blood cultures, urinalysis, bacterial ( Mycoplasma pneumoniae , Chlamydia pneumoniae , Legionella) and viral (cytomegalovirus, …