Churg Strauss Syndrome after Introducing Oral Steroid to Inhaler - A Report of Three Cases

The tetrad of bronchial asthma, severe sinusitis, nasal polyp, eosinophilia, and systemicvasculitis is the main feature of allergic granulomatosis and angitis (churg- strauss syndrome).this vasculitis is usually seen idiopathic in patients with a long history of asthma; oral steroidsusing steroid inhalers, vaccination and desensitization might be triggering factors. drugs such asleukotriene receptor antagonists (ltras), penicillin, sulphonamides, anticonvulsants andthiazides have also been implicated. by presenting the cases in this article, the authors suggestthat some cases of css may be partially or totally suppressed by corticosteroid therapy ofasthma for long periods and replacing oral steroid by inhaler will reveal a pathologic conditionof css, called frustes css forms.we report three subjects with asthma who had been receiving previously multiplecorticosteroid courses for control, but when systemic corticosteroids were discontinued orswitched over to steroid inhaler, the patients developed a similar syndrome.