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Clinical Problem Solving: Radiology
August 2005

Radiology Quiz Case 2

Author Affiliations
 

R. NICKBRYANMDPATRICIA A.HUDGINSMD

Arch Otolaryngol Head Neck Surg. 2005;131(8):739. doi:10.1001/archotol.131.8.739

A 52-year-old man with chronic polypoidal sinusitis, which had been endoscopically treated 2 years earlier, and known Churg-Strauss syndrome (CSS) presented to the emergency department with an acute onset of pyrexia (temperature, 38°C), right orbital swelling, pain, and diplopia. At the time of admission, he was taking azathioprine (150 mg) and prednisolone (10 mg/d). Five years earlier, he had presented with ischemic optic neuritis, eosinophilia, leukocytoclastic vasculitis, and peripheral neuropathy, along with a relatively short history of asthma and rhinosinusitis. The optic neuritis responded completely to intravenous therapy with cyclophosphamide and methylprednisolone. The diagnosis was subsequently confirmed by an elevated titer of antimyeloperoxidase antibodies and by a skin biopsy specimen that demonstrated vasculitis with extravascular eosinophils.

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