Uehara Masashi, Hashimoto Takao, Sasahara Etsuko, Higuchi Kayoko, Matsubara Kunihiko, Ikeda Shu-Ichi
Department of Neurology, Aizawa Hospital, 2-5-1 Honjo, Matsumoto 390-8510, Japan.
J Clin Neurosci. 2009 Sep;16(9):1232-3. doi: 10.1016/j.jocn.2008.11.007. Epub 2009 Jun 3.
A 68-year-old woman with a 4 year history of bronchial asthma developed marked myalgia in the extremities following exercise to which she was unaccustomed. Examination on admission, 11 days after onset, revealed myalgia, muscular weakness and cutaneous hemorrhagic bullae. Blood tests revealed eosinophilia (9160/mm(3)) and elevation of creatinine kinase and C-reactive protein. Muscle biopsy in the quadriceps femoris showed small vessel vasculitis and eosinophilic infiltration. Skin biopsy revealed leukocytoclastic vasculitis with neutrophilic and eosinophilic infiltration and fibrinoid necrosis. We diagnosed her as having Churg-Strauss syndrome (CSS). Corticosteroid treatment relieved her symptoms and resulted in normalization of the laboratory test results. Myositis is rare as an initial manifestation of CSS. The previous studies on immunological changes after eccentric exercise suggest that unaccustomed exercise could induce an increase in the serum level of interleukin-6 and trigger the onset of CSS.
一名68岁女性，有4年支气管哮喘病史，在进行不习惯的运动后出现四肢明显肌痛。发病11天后入院检查发现肌痛、肌肉无力和皮肤出血性大疱。血液检查显示嗜酸性粒细胞增多（9160/mm³）以及肌酸激酶和C反应蛋白升高。股四头肌肌肉活检显示小血管血管炎和嗜酸性粒细胞浸润。皮肤活检显示白细胞破碎性血管炎伴中性粒细胞和嗜酸性粒细胞浸润以及纤维蛋白样坏死。我们诊断她患有变应性肉芽肿性血管炎（CSS）。皮质类固醇治疗缓解了她的症状，并使实验室检查结果恢复正常。肌炎作为CSS的初始表现较为罕见。先前关于离心运动后免疫变化的研究表明，不习惯的运动可能会导致血清白细胞介素-6水平升高并引发CSS的发作。
