The original report by Churg and Strauss [1] and a subsequent report [2] commented that haematuria and proteinuria were common findings in renal involvement in ChurgStrauss syndrome (CSS). However, analysis of urinary sediment was not highlighted. Here, we report a patient with CSS who presented with eosinophils in urinary sediment.
The patient was a 54-year-old woman with a 1 year history of bronchial asthma. Two months before admission, she developed numbness of her left hand and, subsequently, numbness developed in both legs. Because of complications of mild pyrexia and weight loss, the patient was admitted. Laboratory findings showed leukocytosis (18 100/µl) and eosinophilia (46.5% of peripheral leukocytes). Levels of serum IgE (2116 IU/l), C-reactive protein (6.28 mg/dl), rheumatoid factor (78.0 IU/ml) and MPO-ANCA (151 EU) were also elevated. Values for serum creatinine (0.53 mg/l) and creatinine clearance (88.2 ml/min) were within normal range. Although the excretion of urinary protein was mild (1.16 g/day), findings from examination of urinary sediment were multifactorial. Specifically, a large number of red blood cells (RBCs) [>100/high power field (HF)] and white blood cells (WBCs) (3050/HF) were observed together with hyaline (14/HF), granular (01/low power field), RBC and WBC casts. Renal histology showed (Figure 1a): (i) tubulointerstitial nephritis with massive infiltration of eosinophils; (ii) vasculitis involving small- and medium-sized vessels; (iii) segmental proliferative glomerulonephritis with cellular crescents; and (iv) some tubules obstructed by casts consisting of eosinophils. Based on the clinical and pathological findings that are defined in the American College of Rheumatology (1990) traditional classification criteria [3], the patient was diagnosed as having CSS. The collected urinary sediment was evaluated by light microscopy using May GrünwaldGiemsa stain (Figure 1b). Surprisingly, 49% of WBCs had eosinophilic granules in their cytoplasm. After initiation of corticosteroid therapy (50 mg/day predonisolone p.o. with tapering), her symptoms gradually disappeared, with the exception of numbness. After 6 weeks, proteinuria was reduced (0.3 g/day) and the urinary sediment presented a nearly normal profile (RBCs: 59/HF; WBCs: 14/HF).
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Conflict of interest statement. None declared.
1Internal Medicine II Nihon University School of Medicine 2Department of Clinical Laboratory Nihon University Itabashi Hospital Tokyo, Japan Email: iohsawa{at}med.nihon-u.ac.jp.
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