Multifocal enhancing cortical lesions in a patient with Churg-Strauss syndrome

Abstract

CNS involvement is rare in Churg-Strauss syndrome (CSS); only approximately 6 to 8% of patients with CSS have CNS complications.1,2 To date, only a few cases of CNS vasculitis in CSS have been described in detail. They usually consist of reports about cerebral infarctions, intracerebral hemorrhages, and subarachnoid hemorrhages.1–6 Herein, we describe a patient with CSS presenting as multifocal enhancing cortical lesions on MRI. ### Case report. A 62-year-old woman with a history of bronchial asthma for approximately 10 years was admitted to our hospital due to left-sided weakness and visual disturbance. The symptoms developed over 1 week, and were accompanied by multiple skin rashes, occasional fresh hematochezia, and worsening shortness of breath due to frequent attacks of asthma. Her examination was remarkable for erythematous maculopapules distributed over her abdomen and extensor surface of the lower extremities (figure, A), slight tachypnea with a room air saturation of 93%, and expiratory wheezing with inspiratory crackles at bilateral lung bases. Neurologic examination disclosed mild left hemiparesis and binocular blurred vision, especially in the central visual field. Figure Cutaneous lesions and brain MRI findings Multiple erythematous maculopapules are evident on the extensor surface of the lower extremities (A). Biopsy specimens obtained from the skin lesions demonstrated multiple foci of granulomatous angiitis (B) and dense perivascular eosinophilic infiltrates (C) in …