Churg–Strauss syndrome and eosinophilic prostatitis

Abstract

infiltration and extravascular granulomas; the presence of asthma and ANCA positivity with a perinuclear pattern is also often present. Lanham et al. [2] showed that these criteria often do not coexist temporally or spatially and may only be found at the same time in a minority of cases. Churg-Strauss syndrome rarely involves the prostate and then presents with allergic/eosinophilic granulomatous prostatitis. Only 12 patients are reported to have had such prostatitis with asthma, of whom only five had significant blood CASE REPORTA 60-year-old man presented with poor urinary flow, hesitancy and nocturia over 1 month. He had chronic urinary retention with a 1 L residual on catheterization. A peripheral blood count showed a raised white cell count with an eosinophilia of 8.0 ¥ 10 9 (reference range 0.1-0.4 ¥ 10 9 ). Renal ultrasonography showed bilateral hydronephrosis with cortical preservation, and his urea and electrolytes were normal. He underwent TURP and was discharged without a catheter. Histology showed fibromuscular hyperplasia and florid eosinophilic prostatitis; granulomata and vasculitis were specifically noted to be absent (Fig. 1). Two weeks after discharge he was admitted as an emergency with a rash affecting both ankles and legs. A clinical diagnosis of nodular vasculitis consistent with incipient infarction was made, and a biopsy showed a leukocytoclastic vasculitis (Fig. 2). Asthma of recent onset was also noted. Investigations now showed a urea of 9.5 mmol/L, creatinine 209 m mol/L, a white cell count of 18.4 ¥ 10 9 , an eosinophil count of 10.1 ¥ 10 9 /L, an ESR of 87 mm/h, and perinuclear antineutrophil cytoplasmic antibody (ANCA) was positive. There was proteinuria and microscopic haematuria; a chest X-ray showed old pleural calcification of the left lung. The clinical and laboratory findings suggested Churg-Strauss syndrome with cutaneous, prostatic and possibly renal involvement. He was treated with pulsed intravenous methyl prednisolone, oral azathioprine and prednisolone, and his rash settled within 48 h. He developed a bronchopneumonia, which resolved after antibiotics, secondary to immunosuppression. At the time of discharge his electrolytes and eosinophil count had returned to normal. At a urological review 5 months after TURP he was voiding well with a maximum flow rate of 35 mL/s and no residual volume after voiding. COMMENTChurg-Strauss syndrome was originally described in 1951 [1]. The diagnostic criteria include peripheral blood eosinophilia, necrotizing vasculitis with eosinophilic tissue FIG. 1. The histology of the prostate, showing diffuse infiltration of the muscle and glands by an eosinophilic rich infiltrate. Haematoxylin and eosin, ¥ 25, inset ¥ 400. FIG. 2. Small-vessel vasculitis with perivascular fibrin and eosinophils. MSB stain ¥ 100, inset ¥ 400.

Churg–Strauss syndrome presenting with eosinophilic prostatitis

“…However, eosinophilic infiltration into the prostate associ-ated with this syndrome has been rarely reported. 4 In the present case, deterioration of urinary symptoms were provably related to the eosinophilic infiltration into the prostate.…”

“…The organs commonly involved by CSS are lung, heart, nerves, skin and gastrointestinal tract 2,3 . However, eosinophilic prostatitis associated with this syndrome has rarely been reported 4 . We describe a patient with acute urinary retention related to eosinophilic prostatitis.…”

“…2,3 However, eosinophilic prostatitis associated with this syndrome has rarely been reported. 4 We describe a patient with acute urinary retention related to eosinophilic prostatitis.…”

Urological Manifestations of the Systemic Vasculitides—A Scoping Review

“…Two weeks after discharge, he was admitted as an emergency with a rash affecting both ankles and legs. The clinical and laboratory findings suggested EGPA with cutaneous, prostatic, and possibly renal involvement [57].…”