P115 | Churg-Strauss syndrome presenting with pericarditis

A. Parisi¹, E. Marrone², G. Di Monda², F. Gallucci², F. Cinque², R. Muscherà², D. Morelli², R. Buono³, P. Morella² | ¹UOC Medicina 3, AORN A. Cardarelli, Napoli, ²UOC Medicina 3, AORN A. Cardarelli, Napoli, ³UOS Reumatologia, AORN A. Cardarelli, Napoli, Italy

Premises: Churg-Strauss syndrome (CSS) is a rare systemic vasculitis, that affects medium-sized vessels, involves multiple organs and in the majority of cases is related to asthma and eosinophilia. We report the case of a young woman with acute pericarditis.
Description of the Case report: A 24-year-old woman with a history of allergic rhinitis, asthma and nasal polyposis was admitted at our emergency department for chest pain and bilateral lower extremity weakness with paresthesia. Laboratory tests showed eosinophilia (8.23 × 103/ul), elevated C-reactive protein (112 mg/dl, n.v <5 mg/dl) and elevated biochemical markers of myocardial injury (troponin 0.46 ng/ml, n.v.<0.3 ng/ml). The electrocardiogram was negative. Transthoracic echocardiography revealed a small pericardial effusion with no other abnormalities. Hearth magnetic resonance imaging was permormed and confirmed a diagnosis of pericarditis. Immunologic study showed ANA and ANCA positive, in particular ANA 1:100, p-ANCA 134 U/l (nv<3.5), and elevated IgE. Electromyography revealed sensory-motor symmetric axonal neuropathy. She had also arthritis of the right wrist. This presentation led to a diagnosis of CSS and appropriate therapy with corticosteroid, colchicine and mepolizumab resulted in a remission of disease activity.
Conclusions: Because of its multiple forms of presentation and multiorgan involvement, diagnosis of CSS can be difficult. Physicians should thus be alert to the possibility of CSS as a differential diagnosis in patients presenting with pericarditis, whenever the clinical setting is appropriate.