case of Churg-Strauss syndrome treated with Montelukast

To report a case of Churg-Strauss syndrome who had asthma and allergic rhinitis treated with montelukast. A nonsmoking 59-year-old woman presented with fever, hemoptysis and dyspnea. Past medical history included allergic rhinitis and asthma which were diagnosed 18 years ago. The asthma was treated successfully with inhaled salmeterol and beclamethasone. She also received montelukast [10 mg/day] for 3 years. Although her chest X-ray was normal a week earlier, she had widespread bilateral pulmonary infiltrates on admission. She had leukocytosis [12.5 x 109/l] with eosinophilia [15.6%]. Her total IgE count was 550 U/ml. Testing for protoplasmic-staining antineutrophil cytoplasmic antibodies was positive. Bronchoalveolar lavage could not be performed due to bronchospasm and severe hypoxemia; however, mucosal biopsies were obtained, which revealed eosinophil leukocytes in the lumen and walls of small vessels. She was diagnosed to have Churg-Strauss syndrome and had remarkable clinical improvement on day 5 with high-dose of oral prednisolone [50 mg/day]. Radiological improvement was detected at the end of the second week. This case shows the importance of being aware that leukotriene receptor antagonists could cause Churg-Strauss syndrome, in spite of the uncertainty about its mechanism

Seven years experience of bronchogenic cysts

To reveal the clinical, radiological, and surgical results of bronchogenic cysts. Patients that underwent surgical procedure between January 2000 and June 2007, at Izmir Dr. Suat Seren Chest Disease and Thoracic Surgery Training Hospital, Izmir, Turkey with a radiological diagnosis of bronchogenic cyst were assessed retrospectively. Patients with confirmed histopathologically bronchogenic cyst [n=28] were evaluated for age, gender, symptoms, clinical and radiological signs, procedure of surgical treatment, and post-operative complications. There were 12 females, 16 males, and the mean age was 45.3 [25-73] years. Cysts were located at the pulmonary parenchyma in 53.5%, at the mediastinum in 43%, and at the intrathoracic extrapulmonary in 3.5%. There was no relation between localization and gender [p=0.276], and localization and the presence of symptoms [p=0.409]. Frequently seen symptoms were dyspnea and chest pain. Cysts were infected in 11%, and intact in 89%. The average diameter of the cysts was 6.18 cm [2-12]. Surgical complete resection was performed via thoracotomy in all patients. Mean follow-up time was 36 months, and there was no death. Minor postoperative complications occurred in 3 patients. Radiology alone may not be enough for diagnosis of bronchogenic cysts in all patients. Early surgical intervention is suggested for the exact diagnosis and prevention of operative difficulties and complications