Churg-Strauss syndrome: clinical presentation of eosinophilic vasculitis in a critically ill patient. A case report

Abstract

Eosinophilic granulomatosis with polyangiitis (EGPA), formerly known as Churg-Strauss syndrome,
is a rare systemic vasculitis affecting small- and medium-sized vessels. It is characterized by late-onset asthma, peripheral eosinophilia and multiorgan involvement, which may include respiratory, cutaneous, renal, neurological and hematological manifestations. Diagnosis is challenging due to clinical variability and overlapping manifestations with other inflammatory diseases.
We present the case of a 58-year-old woman with a history of hypertension and Class III obesity,
who was admitted to the emergency department with severe respiratory failure and a six-month
history of asthma. During her hospitalization, she developed marked hypereosinophilia, painless
cutaneous lesions compatible with vasculitis, acute renal impairment and thrombocytopenia
associated with a positive Coombs test. Despite negative c-ANCA and p-ANCA results, the diagnosis
of EGPA was made based on clinical findings and subsequently confirmed by histopathological
examination, which revealed eosinophil-rich inflammatory infiltrates. Treatment was provided
with corticosteroid pulses and immunosuppression with rituximab, achieving complete resolution
of the multisystemic manifestations and hospital discharge in stable condition. This case underscores the importance of prompt diagnosis in rare diseases such as EGPA, where clinical suspicion and early therapeutic intervention with corticosteroids and immunosuppressants are essential for successful treatment. It also highlights the need for a multidisciplinary approach in the management of such patients, particularly in critical care settings.