Churg Strauss Syndrome
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Transcript of Churg Strauss Syndrome
- 1. Case presentation
2. 59 CC: 5 PI:1PTA URI symptom 5PTA . 3PTA . . 3. Past Hx :2PT . 10PTA - 4. Physical examination BT 38 cPR 100/min BP 120/80 mmHg RR 24/min Conscious, not pale, no malar rash, no oral ulcerLN -ve skin :hyperpigmented scar with hemorrhagic crust both forearms and legs lung :clear, equal BS heart:regular, normal s1s2,no murmur abd:soft, not tender, no mass,no hepatosplenomegaly neuro: pupil 3 mm RTL BE, decrease motor tone all extremities 5. Motor: Rt. Lt.DTRRt.Lt. deltoidIV IV bicepsIII+IV01+ tricepsIII+II 01+ wrist EX/FLEXIV/II0/000hip E/FIV/IIIV/IV knee E/FV/IIIV/III02+ ankle E/FV/IIV/I01+ Sensory: impaired both hand and feet above ankle BBK: plantar flexion Propioception: impaired 6. Problem list
- Acute Symmetrical weakness
- Hx of asthma
- Hx recurrent pruritus
7. Laboratory CBC:wbc 21,950Hct 35plt 277,000 N 42.5, L 12.3, Mo 3.4, Eo41.7 normochromic normocytic Rbc UA:sp.gr. 1.015, prot/sugar ve, Wbc 0-1,Rbc 0-1 FBS147,BUN 5,Cr 0.39 E lyteNa126,K 3.4,Cl 82,CO2 25,Ca 2 +9.1 LFTAlb 4.0,Glob4.0, AST 55,ALT 59,Alk 185 CPK356 ESR77 8. LaboratoryANA HT,chorea,seizures, testicular pain
- Few pathology report
- Steroid is standard Rx
62. LTRAvsCSS 63.
- Since 1999-2009
- Conflict data
- Difficult to research design
- What is hypothesis for LTRA induce CSS ?
64. 65. 66. 67. 68. 69. 70. 71. LTRA ICS SABA LABA 72. 73. 74. 75. Quiz
- Which of the following is not criteria for Dx CSS in ACR criteria?
- 1. asthma
- 2. eosinophillia > 10%
- 3. systemic vasculitis
- 4. paranasal sinus abnormality
- 5. neuropathy
76.
- Which HLA may be associated with CSS ?
- 1. HLA-B27
- 2. HLA-DRB4
- 3. HLA-C
- 4. HLA-DR2
- 5. HLA-DR3
77.
- All the following are poor prognostic factor for CSS except_______
- 1. nephrotic range proteinuria
- 2. renal failure
- 3. GI involvement
- 4. mononeuritis multiplex
- 5. cardiomyopathy
78.
- Subgroup of CSS is differentiate by ANCA status, which one is not clinical of ANCA +ve patient ?
- 1. cardiomyopathy
- 2. small vss. Vasculitis
- 3. glomerulonephritis
- 4. pulmonary hemorrhage
- 5. purpura
79.
- Which one of the following is true in childhood CSS ?
- 1. incidence of CSS is similar between
- children and adult
- 2. ANCA +ve 50% of case
- 3. usually require 2 ndline Rx
- 4. HT is common problem in childhood CSS
- 5. pathogenesis of CSS in chlidren differ
- from adult
80.
- female 52 yrs Hx asthma 20 yrs on ICS , monteleukast,present with progressive dyspnea on intermittent short course oral steroid
- PE wheezing and crackle both lung no clubbing
- CBC wbc 10200 Eo 23 % skin test alternaria , aspergillus +ve
- ESR 70IgE 500CXR bilateral parenchymal infiltrationCTchest peripheral airspace subpleural consolidationWhat is diagnosis ?
- 1. CSS
- 2. chronic eosinophillic pneumonia
- 3. usual interstitial pneumonia
- 4. ABPA
- 5. Idiopathic eosinophillic syndrome
81. Take home messege
- Clinical manifestration of CSS
- Pathogenesis is unknown
- CSS in children
- LTRA and CSS association
- Further research direction
82. THANK YOUFORYOUR ATTENTION 83. 84. Differential diagnosis 1.29 85. 1.13