Churg-Strauss syndrome after reduction of inhaled corticosteroid in a patient treated with pranlukast for asthma

Intern Med. 2001 May;40(5):432-4. doi: 10.2169/internalmedicine.40.432.


Recently, various forms of Churg-Strauss syndrome (CSS) have been reported in association with the use of leukotriene receptor antagonists. A 53-year-old woman with a 5-year history of asthma associated with chronic sinusitis presented mononeuropathy, hypereosinophilia, and positive P-ANCA in October 1999. She had been treated with pranlukast (450 mg/day) and beclomethasone dipropionate (BDP) at a dose of 1,200 microg/day which had gradually been tapered to 800 microg/day over the previous 17 months. She was found to have CSS, and 60 mg/day of prednisolone was administered instead of pranlukast, resulting in an improvement of her symptoms and eosinophilia. Later, we confirmed that serum P-ANCA had been positive before the pranlukast treatment, but CSS vasculitis had not appeared at that time. We speculated that an underlying incomplete form of CSS was being masked in this case and that the reduction of inhaled corticosteroid might have been responsible for the unmasking of CSS.

Publication types

  • Case Reports

MeSH terms

  • Administration, Inhalation
  • Administration, Topical
  • Anti-Asthmatic Agents / administration & dosage*
  • Anti-Asthmatic Agents / adverse effects*
  • Anti-Asthmatic Agents / therapeutic use
  • Anti-Inflammatory Agents / administration & dosage*
  • Anti-Inflammatory Agents / therapeutic use
  • Asthma / drug therapy*
  • Beclomethasone / administration & dosage*
  • Beclomethasone / therapeutic use
  • Chromones / adverse effects*
  • Churg-Strauss Syndrome / chemically induced*
  • Churg-Strauss Syndrome / drug therapy
  • Female
  • Glucocorticoids
  • Humans
  • Leukotriene Antagonists / adverse effects*
  • Middle Aged


  • Anti-Asthmatic Agents
  • Anti-Inflammatory Agents
  • Chromones
  • Glucocorticoids
  • Leukotriene Antagonists
  • Beclomethasone
  • pranlukast