Ramakrishna G, Connolly H M, Tazelaar H D, Mullany C J, Midthun D E
Department of Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
Mayo Clin Proc. 2000 Jun;75(6):631-5. doi: 10.4065/75.6.631.
A 34-year-old woman with asthma had increasing dyspnea on exertion for 9 months and new-onset mononeuritis multiplex. An examination demonstrated sinus tachycardia, elevated jugular venous pressure, and a tender nonpulsatile liver. The leukocyte count was 15.8 x 10(9)/L, with 23% eosinophils. Echocardiography revealed a laminated thrombus obliterating much of the right ventricular cavity, with encasement of the tricuspid valve. Ultrafast computed tomography showed no evidence of pulmonary emboli. Biopsy specimens of skin nodules revealed extravascular palisading granulomas. The thrombus was refractory to corticosteroids, and right ventricular thrombectomy was performed. To our knowledge, this is the third reported case of Churg-Strauss syndrome with thrombotic complications from coexistent eosinophilic endomyocarditis. In an asthmatic patient with chronic dyspnea, eosinophilic tissue infiltration, and neuropathy, Churg-Strauss syndrome should be considered; evaluation for cardiac involvement may be warranted.
一名34岁的哮喘女性患者，劳力性呼吸困难加重9个月，并出现新发多发性单神经炎。检查发现窦性心动过速、颈静脉压升高以及肝脏压痛但无搏动。白细胞计数为15.8×10⁹/L，嗜酸性粒细胞占23%。超声心动图显示有一层状血栓几乎完全闭塞右心室腔，并包绕三尖瓣。超速计算机断层扫描未发现肺栓塞证据。皮肤结节活检标本显示血管外栅栏状肉芽肿。该血栓对皮质类固醇治疗无效，遂行右心室血栓切除术。据我们所知，这是第三例报道的伴有嗜酸性粒细胞性心内膜炎血栓形成并发症的Churg-Strauss综合征病例。对于患有慢性呼吸困难、嗜酸性组织浸润和神经病变的哮喘患者，应考虑Churg-Strauss综合征；可能需要评估心脏受累情况。
