[Bilateral exophthalmos requiring rheumatologic consultation. A case of the Churg-Strauss syndrome]. / Wytrzeszcz obustronny--wskazana konsultacja reumatologiczna. Opis przypadku zespolu Churga i Strauss.

INTRODUCTION: The Churg-Strauss syndrome is a necrotic eosinophilic vasculitis affecting small and medium vessels. The etiology of this disease known to have an autoimmune background remains unclear. The Churg-Strauss syndrome is progressive and may involve multiple organs. Clinical manifestations are variegate, impeding the diagnosis. Typical symptoms include asthma, eosinophilia, mono- and polyneuropathy, sinusitis, pulmonary lesions and heart involvement. MATERIAL AND METHODS: We present a case of a patient with bronchial asthma who developed chronic sinusitis of the ethmoid, maxillary, and paranasal sinuses at the age of 37 years and was operated four times for this reason. At this age the patient also developed bilateral exophthalmos; normal thyroid function stood against the diagnosis of thyroid orbitopathy. The patient was treated by an ophthalmologist with glucocorticosteroids for three years. Glucocorticosteroids were withdrawn at the age of 40 years because of chronic pancreatitis. The patient suffered myocardial infarction at the age of 41 years and was diagnosed with the Churg-Strauss syndrome at the age of 44 years. CONCLUSIONS: The Churg-Strauss syndrome is a rare systemic disease with a variable course and variegate clinical manifestations which may be the reason for diagnostic difficulties.

[Nodular changes in lungs in a patient with rheumatoid arthritis. Diagnostic and therapeutic difficulties. Case report]. / Guzkowe zmiany w plucach u pacjenta z reumatoidalnym zapaleniem stawów. Trudnosci diagnostyczne i terapeutyczne. Opis przypadku.

Rheumatoid arthritis is a systemic inflammatory disease characterized by destructive synovitis and systemic extra-articular involvement exemplified by rheumatoid nodules occurring in the skin, lungs, and other parenchymatous organs. Antirheumatic drugs like methotrexate and leflunomide are known to predispose to the development of pulmonary rheumatoid nodules. We report the case of a 60-year-old male with rheumatoid arthritis previously treated with methotrexate and cyclosporin, in whom multiple pulmonary nodules were disclosed. The patient was extensively diagnosed to exclude any malignancy. Pulmonary rheumatoid nodules were recognized, methotrexate was withdrawn, and cyclophosphamide pulses were started. The size of the nodules decreased and the patient was started on cyclosporin.