A 57-year-old Malay man presented to the local emergency department with a 1-month history of intermittent fever, shortness of breath, bilateral lower limb swelling, and recent weight loss of 3 to 4 kg. He also complained of a painful rash over his lower limbs for the past 2 weeks. Clinical examination revealed a clinically unwell man who was febrile but with stable vital signs. Respiratory examination revealed decreased breath sounds bilaterally with basal crepitations but no wheeze. There was bilateral pitting edema up to the mid-shins, but no evidence of congestive cardiac failure. Cutaneous examination revealed multiple tender, palpable vasculitic lesions and purpura over his shins, calves, and ankles bilaterally (Figure 1). Results of the rest of the systemic review, including the neurological examination, were normal.
Yosipovitch G, Tang MBY. Acute Churg-Strauss Syndrome in an Asthmatic Patient Receiving Montelukast Therapy. Arch Dermatol. 2003;139(6):715-718. doi:10.1001/archderm.139.6.715