Churg-Strauss Syndrome Mimicking Parasitic Infestation: Atypical Presentation of A Rare Disease

Context: Churg-Strauss syndrome (CSS) is a rare antineutrophil cytoplasmic antibody associated vasculitis characterized by asthma, chronic rhinosinusitis, and persistent eosinophilia. Although acute diarrhea is frequent clinical manifestations of parasitic infection, it is not a main clinical presentation of CSS. We report a 49-year-old man who presented with acute watery diarrhea and peripheral eosinophilia. Extensive investigations for parasitic infestation were negative. He subsequently underwent colonoscopy which showed numerous serpiginous ulcers throughout the colon. Microscopic examination revealed ulcerated colonic mucosa with eosinophilic infiltration. Further serological investigation demonstrated a positive myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA). The patient was diagnosed with CSS and treatment with high dose oral corticosteroid was initiated and gradually tapered. His diarrhea, shortness of breath, rash, eosinophilia and pulmonary infiltration dramatically improved after the treatment. Conclusion: Although gastrointestinal symptoms are not main clinical presentations of CSS. Acute diarrhea with peripheral eosinophilia should raise the suspicious of CSS, especially after excluding the possibility of parasitic infestation. Journal of Nature and Science, 1(5):e105, 2015