ABSTRACT
Churg-Strauss syndrome is a rare systemic vasculitis occurring in patients with asthma and peripheral eosinophilia. Lungs, skin, and the nervous system are the most common sites of involvement, although many other organs are affected frequently. We report a case of 54-year-old male with a history of asthma and chronic rhinosinusitis who was admitted to the emergency department because of dyspnea and pleural pain. He was diagnosed with Churg-Strauss syndrome based on bronchial asthma, peripheral eosinophilia, pulmonary infiltration, chronic rhinosinusitis, and extravascular eosinophil infiltration. His symptoms were resolved dramatically after treatment with corticosteroids. Allergic rhinitis and chronic rhinosinusitis with or without polyps may be present at the early stage of Churg-Strauss syndrome. Therefore, otolaryngologists may play a pivotal role in making an early diagnosis of this disease.
Subject(s)
Humans , Male , Middle Aged , Adrenal Cortex Hormones , Asthma , Churg-Strauss Syndrome , Dyspnea , Early Diagnosis , Emergency Service, Hospital , Eosinophilia , Eosinophils , Lung , Nasal Cavity , Nervous System , Polyps , Pulmonary Eosinophilia , Rhinitis , Skin , Systemic Vasculitis , VasculitisABSTRACT
Allergic reaction to insulin is mediated by several mechanisms; differences in amino acid sequence of animal and human insulin, altered tertiary structure of insulin and the presence of non-insulin protein contaminants or pharmaceutical additives. Anaphylactic reactions to insulin only occur in 0.1 to 2% of patients who stopped insulin therapy and have then resumed treatment. We report a diabetic patient who suffered severe anaphylactic reactions to human recombinant insulin, successfully treated by desensitization. A 19-year-old man with type 1 diabetes receiving Insulatard HM(R) developed generalized urticaria and angioedema with progression to dyspnea, dizziness and syncope. Skin prick test to all kinds of human recombinant insulin products revealed immediate type hypersensitivity and the titer of insulin IgE was increased in serum. The desensitization trial with Velosulin HM(R) using modified desensitization method was performed. Six months after the desensitization he was taking Velosulin HM(R) as well as Insulatard HM(R) without any evidence of systemic allergic reactions.