Hashimoto M, Fujishima T, Tanaka H, Kon H, Saikai T, Suzuki A, Nakatsugawa M, Abe S
Third Department of Internal Medicine, Sapporo Medical University School of Medicine.
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.
最近，有报道称各种形式的变应性肉芽肿性血管炎（CSS）与白三烯受体拮抗剂的使用有关。一名患有哮喘伴慢性鼻窦炎5年的53岁女性于1999年10月出现单神经病、嗜酸性粒细胞增多和P-ANCA阳性。她曾接受普仑司特（450毫克/天）和二丙酸倍氯米松（BDP）治疗，剂量为1200微克/天，在过去17个月中逐渐减至800微克/天。她被诊断为CSS，于是停用普仑司特，改为使用60毫克/天的泼尼松龙，症状和嗜酸性粒细胞增多情况有所改善。后来，我们证实该患者在使用普仑司特治疗前血清P-ANCA就呈阳性，但当时CSS血管炎并未出现。我们推测该病例中存在潜在的不完全型CSS，而吸入性糖皮质激素剂量的减少可能是CSS显现的原因。
