Le Syndrome du pot de chambre (French Edition)

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We reported a female patient, aged 80 years, with asthma for many decades and repeatedly verified eosinophilia in peripheral blood, in which CSS was suspected only after the occurrence of skin changes in the form of vesicles, vesiculopustule, purpuric macula, papule and petechiae. Further tests verified pulmonary infiltrates, paranasal sinusitis, extravascular eosinophils on histopathologic sample of skin tissue, and polyneuropathy.

Despite long-standing pulmonary symptoms and laboratory findings of eosinophilia, the appearance of skin changes raised suspicion of possible CSS. Skin changes resolved and the patient was reffered to rheumatologist. Coronary involvement in Churg-Strauss syndrome. Systemic autoimmune diseases are themselves a relevant and independent risk factor for atherosclerosis and coronary ectasia. We describe a case of a year-old Caucasian man who was admitted to our department for unstable angina. History of asthma, paranasal sinus abnormality, and peripheral eosinophilia given a high suspicion of Churg-Strauss syndrome CSS.

Diagnosis was performed with 5 of the 6 American College of Rheumatology criteria. The knowledge that CSS is often associated with significant coronary artery involvement and the persistence of chest pain led us to performing immediately a coronary angiography. Coronary angiography showed diffuse ectasic lesions, chronic occlusion of left anterior descending artery with homocoronary collateral circulation from left circumflex artery and subocclusive stenosis in the proximal tract of posterior descending artery. The early recognition of CSS, an aggressive invasive diagnostic approach, and an early appropriate therapy are important to prevent the progressive and permanent cardiac damage in these patients.

In the setting of a multidisciplinary approach, careful cardiac assessment is an essential step in CSS, even in mildly symptomatic patients. Published by Elsevier B. A case of Churg-Strauss syndrome: A case is presented of Churg-Strauss syndrome in a young man in whom the definitive diagnostic procedure was a full thickness sigmoidoscopic rectal biopsy, with submucosal sampling.

Gastrointestinal changes in Churg-Strauss syndrome , a rare systemic illness characterised by asthma, blood and tissue eosinophilia, vasculitis, and granulomatous inflammation are common but poorly reported. The endoscopic and histopathological features of a case are described and emphasise the potential value of a limited sigmoidoscopy in establishing the diagnosis, when lower gastrointestinal symptoms are present.

Chronic calcific constrictive pericarditis complicating Churg-Strauss syndrome: Churg-Strauss syndrome is a necrotizing systemic vasculitis characterized by extravascular granulomas and eosinophilic infiltrates of small vessels. Although cardiac complications are considered to be relatively common, no case of constrictive calcified pericarditis has ever been previously described in this setting.

In this report, we present the case of a year-old man with Churg-Strauss syndrome , in whom we were able to document the development of symptomatic calcific constrictive pericarditis during a year period despite long-term corticosteroid therapy. Crescentic glomerulonephritis in non-asthmatic Churg-Strauss syndrome. A year-old male presented with sensory motor polyneuropathy and rapidly progressive renal failure. Investigations revealed marked peripheral eosinophilia and elevated perinuclear antineutrophil cytoplasmic antibody titers. Renal biopsy showed pauci-immune cre-scentic glomerulonephritis with interstitial eosinophil infiltrates.

He had no history of asthma. Computed tomography of the chest and X-ray of the paranasal sinuses were normal. On Day 1, the patient developed ileal perforation. Resected ileal segments showed small vessel vasculitis with extravascular eosinophils. A diagnosis of non-asthmatic variant of Churg-Strauss syndrome was made. Renal recovery was achieved in 12 weeks with a combination therapy of corticosteroid and cyclophosphamide. The patient has been relapse-free for 12 months on oral prednisolone therapy. Churg-Strauss syndrome concomitant with chronic symmetrical dacryoadenitis suggesting Mikulicz's disease.

A case of Churg-Strauss syndrome complicated by chronic symmetrical dacryoadenitis suggestive of Mikulicz's disease is herein presented. A year-old Japanese man, who had been previously diagnosed with asthma, presented with weakness of the left leg and purpura on the lower extremities. A neurological examination showed multiple mononeuropathies and a laboratory examination revealed elevated eosinophil counts, IgE levels and the presence of Myeloperoxidase-antineutrophil cytoplasmic antibody MPO-ANCAs. Churg-Strauss syndrome was diagnosed, although the patient also exhibited bilateral swelling of the lachrymal glands.

Furthermore, elevated serum IgG4 levels, an infiltration of a relatively large number of IgG4-positive plasmacytes in the nasal mucosa and hypocomplementemia were also observed. These findings were consistent with a diagnosis of Mikulicz's disease MD. Oral prednisolone 30 mg was administered and the swelling of the lachrymal glands resolved.

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Churg-Strauss syndrome may be accompanied by Mikulicz's disease an IgG4-related disease , and common pathogeneses between Churg-Strauss syndrome and IgG4-related disease may exist. Eosinophilic granulomatosis with polyangiitis Churg-Strauss syndrome presenting as diffuse myositis. Eosinophilic granulomatosis with polyangiitis is a complex multisystemic syndrome with heterogeneous presentation. Most often, there is a clinical history of asthma or other atopic conditions, and current presentation generally includes signs of cutaneous or pulmonary involvement.

Very few reports described myalgia or weakness as the chief complaint. Of these, only a few included muscle biopsy evaluation and none showed convincing evidence of primary myositis. We believe this report is the first to demonstrate true myositis in the setting of early eosinophilic granulomatosis with polyangiitis.

This report describes a 74 year old Caucasian man, with no known allergies, presenting severe myalgia, muscle weakness, jaw claudication, and fever. Blood work showed marked eosinophilia and high creatine kinase levels. Biceps brachialis muscle biopsy revealed eosinophilic necrotizing vasculitis and true myositis with myophagocytosis of non-necrotic fibers and strong sarcolemmal MHC-1 overexpression by immunohistochemistry. This patient was successfully treated with prednisone and azathioprine. Our finding of true myositis in a case of eosinophilic granulomatosis with polyangiitis suggests that primary auto-immunity against muscle fibers, distinct from the secondary effects of vasculitis, can occur in this entity and may represent an overlap syndrome.

Early recognition of eosinophilic granulomatosis with polyangiitis in patients presenting with myositis may provide an opportunity to treat the vasculitis before onset of severe multisystemic disease. We recommend the use of muscle biopsy with immunohistochemistry for MHC-1 to confirm the diagnosis of myositis in the setting of eosinophilic granulomatosis with polyangiitis.

Churg Strauss syndrome associated with montelukast--case report. Churg-Strauss Syndrome allergic granulomatous angiitis is a rare systemic and pulmonary vasculitis. The patient was admitted in our hospital with fever, malaise, sensory deficits in the lower extremities, diffuse musculoskeletal and thoracic pain. Pulmonary infiltrates with eosinophilia can be used to define eosinophilic lung diseases.

We made the differential diagnosis of eosinophilic lung disease: Bronchoalveolar lavage showed Few days after hospital admission patient experienced nausea, vomiting and diarrhea. She underwent a digestive endoscopy, which showed eosinophilic enteritis according to colon biopsy. Nasal mucosa biopsy found granulomas. Anti-neutrophil cytoplasmatic antibody ANCA was positive at 1: This case report illustrates the importance of early diagnosis of Churg-Strauss syndrome and the possible pathogenic link between leukotriene receptor antagonist use and CSS development.

Cutaneous manifestations of Churg-Strauss syndrome: Churg-Strauss syndrome is a rare systemic vasculitis characterized by asthma and other allergy symptoms as well as eosinophilia and necrotizing vasculitis involving small and medium-sized vessels. Its prevalence in the general population ranges from cases per million a year, varying according to the population studied.

The authors describe a case of a female patient affected by the disease with important systemic manifestations and not very florid skin lesions. Usefulness of cardiac resonance imaging in Churg-Strauss syndrome. Churg-Strauss syndrome CSS is a rare entity that is characterized by widespread vasculitis, which affects both small and medium-sized blood vessels of nearly all organs.

We describe a case of a patient with cardiac biopsy proven CSS, and we discuss the usefulness of cardiovascular MRI for its diagnosis. Eosinophilic granulomatosis with polyangiitis is a rare primary vasculitic disease characterized by hypereosinophilia, late onset asthma and extravascular eosinophil granulomas. We report a case presented initially with acute myocardial infarction which later only proceed with asthma, skin manifestations and peripheral neuropathy.

Laboratory parameters showed hypereosinohpilia with negative perinuclear pattern of antineutrophil cytoplasmic autoantibodies p-ANCA. Skin biopsy showed leucocytoclastic vasculitis with eosinophilic infiltration while coronary angiography was normal. The patient's symptoms improved with IV methylprednisolone, pulse cyclophosphamide and azathioprine. Churg-Strauss syndrome CSS is a vasculitis syndromes and is only rarely complicated by subarachnoid hemorrhage. In the current report, we describe a case of CSS with subarachnoid hemorrhage, which showed a favorable outcome following conservative treatment.

After 2 months, he presented sudden pain in the occipitocervical area, and CT revealed subarachnoid hemorrhage. Although both findings suggested cerebral artery dissection, the source of hemorrhage could not be identified. The Japanese Guidelines for the Management of Stroke recommends early diagnosis and treatment of hemorrhagic cerebral artery dissection because of the high risk of re-bleeding.

However, considering the risks of vasculitis aggravation, development of systemic complications, and recurrence, conservative treatment was selected.

Chamber pot

In addition, owing to the risk of complications associated with the frequent use of iodinated contrast agents and angiography procedures, patient was followed up using MRI. His course was favorable, and he was discharged despite mild right abducens paralysis. When patients with hemorrhagic cerebral artery dissection have a history of allergic diseases, CCS should be considered; conservative treatment consisting of rest, strict blood pressure control, and steroid therapy may be the most appropriate option for certain patients.

Churg-Strauss syndrome CSS is a granulomatous small vessel vasculitis. It is characterized by asthma, allergic granulomatosis and vasculitis. This syndrome is rare in children. A 5 years old boy was admitted with cough, fever and dyspnea for 2 weeks. On the basis of laboratory data peripheral eosinophilia , associated with skin biopsy, and history of CSS in his sister, this disease was eventually diagnosed.

The patient had good response to corticosteroid. In every asthmatic patient with prolonged fever, eosinophilia and multisystemic involvment, CSS should be considered. A woman in her 70s with Churg-Strauss syndrome presented with epigastric pain. She was being treated with steroids at the time of admission. Computed tomography showed swelling of the gallbladder, and percutaneous transhepatic cholangiography revealed bloody secretion.

On duodenoscopy, bleeding was observed from the orifice of the major duodenal papilla. Emergency cholecystectomy was performed under a diagnosis of hemorrhagic cholecystitis;intraoperatively, extensive hematoma was detected in the thickened wall of the gallbladder. Subsequent histopathological examination revealed mucosal ulceration with infiltration of inflammatory cells, torn small vessels, and extensive transmural bleeding and abscess formation in the thickened wall of the gallbladder.

We considered that the hemorrhagic cholecystitis was induced by either vasculitis or corticosteroid therapy. To the best of our knowledge, this is the first report of hemorrhagic cholecystitis associated with Churg-Strauss syndrome. Anterior ischemic optic neuropathy in a patient with Churg-Strauss syndrome. We describe a patient with Churg-Strauss syndrome who developed unilateral anterior ischemic optic neuropathy.

A year-old man with a history of bronchial asthma, allergic rhinitis, and sinusitis presented with sudden decreased visual acuity in his right eye that had begun 2 weeks previously. Ophthalmoscopic examination revealed a diffusely swollen right optic disc and splinter hemorrhages at its margin. Goldmann perimetry showed central scotomas in the right eye and fluorescein angiography showed remarkable hyperfluorescence of the right optic nerve head. Marked peripheral eosinphilia, extravascular eosinophils in a bronchial biopsy specimen, and an increased sedimentation rate supported the diagnosis of Churg-Strauss syndrome.

Therapy with methylprednisolone corrected the laboratory abnormalities, improved clinical features, and preserved vision, except for the right central visual field defect. Early recognition of this systemic disease by ophthalmologists may help in preventing severe ocular complications. A twenty year old male presented with purpuric lesions with chronic painful ulcers over the lower extremities and a recurrent pruritic rash on the trunk for 10 years. He was diagnosed as idiopathic leukocytoclastic vasculitis LCV after investigations failed to reveal a systemic association.

He was treated with immunosuppressants at each visit with partial remission. In , he was diagnosed with bronchial asthma and allergic rhinitis. In his recent admission, he showed necrotic ulcers on legs and extensive shiny, truncal micropapules. Examination revealed maxillary sinus tenderness and loss of sensation on the medial aspect of the left lower limb. Radiography confirmed maxillary sinusitis, nerve conduction studies revealed mononeuritis of the anterior tibial nerve and pulmonary function tests PFT were normal. This report highlights the development of full-blown CSS over a period of 12 years in a patient initially diagnosed as idiopathic LCV, emphasizing the need for regular follow-up of resistant and recurrent cases of LCV.

To describe a central retinal artery occlusion in a patient with antineutrophil cytoplasmic antibody ANCA negative Churg-Strauss syndrome. Review of clinical and laboratory findings of a year-old woman with ANCA negative Churg-Strauss syndrome that developed sudden vision loss in left eye. Left central retinal artery occlusion was diagnosed by retinal whitening, a cherry-red spot, and delayed arterial filling on fluorescein angiography.

Patients with this diagnosis should be considered for prophylactic high dose corticosteroid, regardless of their ANCA status. Microvascular vaso-occlusion leading to digital gangrene is not a feature of CSS. While the full clinical spectrum of Churg Strauss Syndrome is still being defined, identification of additional features associated with this syndrome might help to better understand the pathogenesis of the disease and to have an impact on management and prognosis. Cutting edge issues in the Churg-Strauss syndrome.

Churg-Strauss syndrome CSS is a rare systemic small-vessel vasculitis that develops in the background of bronchial asthma, which is characterized by eosinophilia and eosinophilic infiltration of various tissues. It belongs to the group of antineutrophil cytoplasmic autoantibody ANCA -associated vasculitides.

The triggering factors and pathogenesis of CSS are still unknown. The possible role of eotaxin-3 and CCR4-related chemokines in selective recruitment of eosinophils to the target tissues in CSS has been recently suggested, but the role of eosinophilic inflammation in the development of vasculitic lesions is not completely understood. From the clinical view, two distinct phenotypes of the disease are slowly emerging depending on the ANCA-positivity status.

Glucocorticoids are still the mainstay of treatment; however, data are accumulating regarding the beneficial role of novel immunosuppressants and biologic compounds, especially in patients with poorer prognosis. EGPA occurs in patients with asthma. Asthma is sever, associated with eosinophilia and extrapulmonary symptoms. Among them, mononeuritis multiplex is the most frequent symptom. When cardiac involvement is present , prognosis is poor. Despite a good overall prognosis, deaths are caused by vasculitis activity, gastrointestinal and cardiac involvement. Treatment is well codified based on steroids, which are quickly effective.

Immunosuppressants combined with corticosteroids are compulsory to treat the most sever forms, mainly when cardiac and gastrointestinal or renal symptoms are present. Churg-Strauss syndrome associated with antiphospholipid antibodies in a patient with retinal vasculitis. We present the case of a year-old woman with unilateral retinal vasculitis. Investigations showed asthma, rhinosinusitis, nasal polyposis, peripheral blood eosinophilia, increased sedimentation rate, proteinuria, and antiphospholipid antibodies. Anti-neutrophil cytoplasmic antibodies ANCA were negative. Although her anti-neutrophil cytoplasmatic antibody ANCA status was negative, taking into account the other clinical and laboratory features, retinal vasculitis was thought to be an ocular manifestation of Churg-Strauss syndrome.

Treatment was started with high-dose corticosteroids and anticoagulant therapy. Clinical features and prognostic factors of Churg-Strauss syndrome. The purposes of our study were to characterize the clinical features of CSS and to identify factors associated with CSS prognosis in Koreans.

Results Data from 52 CSS patients were analyzed. The respiratory tract was the most commonly involved organ Clinical remission occurred in Characteristics of good responders were older age, diagnosis at earlier stages, less cutaneous involvement, more respiratory involvement, high CRP values, and more generalized symptoms.

Churg-Strauss syndrome CSS is a rare systemic necrotizing small-vessel vasculitis, with accompanying bronchial asthma, eosinophilia, and eosinophilic infiltration of various tissues. Data from 52 CSS patients were analyzed. Loeffler's endocarditis is generally caused by hypereosinophilic syndrome. It is a restrictive cardiomyopathy characterized with eosinophilia and eosionophilic penetration leading to the fibrous thickening of endocardium of both ventricles, apical obliteration and heart failure.

We report a case of a year-old male with Loeffler's endocarditis caused by Churg-Strauss syndrome. The echocardiogram showed that biventricular failure with large thrombus in left ventricle. His symptoms and typical echocardiographic findings markedly improved within 2 months after treatment for Churg-Strauss syndrome.

Churg-Strauss syndrome associated with AA amyloidosis: Churg Strauss syndrome is a rare systemic and pulmonary vasculitis exceptionally associated with AA amyloidosis. We report the case of a year old woman with past medical history of asthma. She developed polyarthralgia, headache and purpura.

Renal biopsy showed an important type AA amyloid deposit. The patient was treated with steroids with a good response of the vasculitis and amyloidosis with disappearance of the proteinuria. Sequential rituximab and omalizumab for the treatment of eosinophilic granulomatosis with polyangiitis Churg-Strauss syndrome.

Eosinophilic granulomatosis with polyangiitis EGPA , formerly known as Churg-Strauss syndrome CSS , is a small vessel vasculitis associated with eosinophilia and asthma. Clinical manifestations commonly seen in patients presenting with EGPA range from upper airway and lung involvement to neurological, cardiac, cutaneous, and renal manifestations. Treatment for severe presentations includes steroids, cyclophosphamide, plasmapheresis, and recently, rituximab.

Rituximab is associated with a good response in the treatment of vasculitis, but a variable response for the control of allergic symptoms. Here, we report a year-old female patient with severe EGPA gastrointestinal and cutaneous vasculitis, rhinitis and asthma refractory to conventional treatment.

She was treated with rituximab, which enabled rapid control of the vasculitis component of the disease, but there was no response to rhinitis and asthma. Additionally, she developed severe bronchospasm during rituximab infusion. Sequential rituximab and omalizumab were initiated, leading to remission of all manifestations of vasculitis, rhinitis, and asthma, in addition to bronchospasm related to rituximab infusion.

Combined Churg-Strauss syndrome and allergic bronchopulmonary aspergillosis - case report and review of the literature. The diagnosis of ABPA was established on the pathological findings of allegic mucin impaction and fungal hyphae on lung biopsy. It was further proved by positive serum IgE and IgG antibodies specific to afumigatus. The role of lung biopsy in the diagnosis of the condition was emphasized. Acute coronary syndrome caused by coronary vasospasms associated with Churg-Strauss syndrome: A year-old woman with a history of aspirin-induced asthma was admitted with severe chest pain.

Emergency coronary angiography revealed coronary artery spasms. The administration of vasodilators did not suppress the anginal symptoms, and the differential white blood cell count continued to show eosinophilia. The patient's symptoms of aspirin-induced asthma, eosinophilia and other allergic states led to the diagnosis of Churg-Strauss syndrome CSS. After starting betamethasone therapy, the eosinophilia and cardiac symptoms rapidly disappeared. Although coronary vasospasms related to CSS are rare, the present case suggests that a differential white blood cell count should be obtained in patients with refractory coronary vasospasms.

Systemic vasculitis is a rare disease, and the diagnosis is very difficult when patient shows atypical symptoms. We experienced an unusual case of dysphagia caused by Churg-Strauss syndrome with lower cranial nerve involvement. A year-old man, with a past history of sinusitis, asthma, and hearing deficiency, was admitted to our department for evaluation of dysphagia. He also complained of recurrent bleeding of nasal cavities and esophagus. Brain magnetic resonance imaging did not show definite abnormality, and electrophysiologic findings were suggestive of mononeuritis multiplex.

Dysphagia had not improved after conventional therapy. Biopsy of the nasal cavity showed extravascular eosinophilic infiltration. All these findings suggested a rare form of Churg-Strauss syndrome involving multiple lower cranial nerves. Dysphagia improved after steroid therapy. A year-old woman was admitted to our chest pain unit because of an acute coronary syndrome non ST-elevation myocardial infarction.

She complained of asthma, chronic sinusitis and involuntary weight loss, occasional fever and night sweats over the past six months.

Coronary angiography did not show any signs of macroscopic coronary artery disease, while echocardiography demonstrated a hemodynamically not significant pericardial effusion. Magnetic resonance imaging of the heart revealed a subendocardial scar, extension and localization pointing to a vascular genesis. Thoracic computed tomography revealed pulmonary opacities and blood tests showed an eosinophilia, leading to the clinical diagnosis of Churg-Strauss syndome. The patient responded quickly to oral steroids, and blood parameters returned to normal.

Acute coronary syndrome in youngish patients without classical cardiovascular risk factors is suggestive for myocarditis but also for vasculitis. Churg-Strauss syndrome usually responds quickly to immunosuppressive therapy, associated with a rather good prognosis without high mortality. Polyangiitis overlap syndrome of granulomatosis with polyangiitis Wegener's granulomatosis and eosinophilic granulomatosis with polyangiitis Churg-Strauss syndrome. Polyangiitis overlap syndrome is defined as systemic vasculitis that cannot be classified into one of the well-defined vasculitic syndromes.

In this report, a female patient who presented with vasculitis-like and asthmatic symptoms was diagnosed as having polyangiitis overlap syndrome of granulomatosis with polyangiitis GPA; formerly known as Wegener's granulomatosis and eosinophilic granulomatosis with polyangiitis EGPA; formerly known as Churg-Strauss syndrome. She was successfully treated with immunosuppressants and steroids and has been in remission for 20 months. It is important to establish a proper diagnosis and introduce an appropriate treatment modality in patients with this rare and serious pathology to prevent irreversible organ damage.

Churg-Strauss syndrome CSS is a systemic necrotizing vasculitis of the small and medium vessels, associated with extravascular eosinophilic granulomas, peripheral eosinophilia, and asthma. The exact etiology of CSS is unknown. This syndrome commonly affects the lungs, peripheral nerves, skin, heart, and gastrointestinal tract, but rarely the central nervous system. Subarachnoid and intracerebral hemorrhage in CSS patients is extremely rare; however, clinicians should consider that CSS may be a cause of intracranial hemorrhage and its high rate of mortality and morbidity.

The authors report on two cases of subarachnoid and intracerebral hemorrhage with CSS and discuss a brief review of CSS. Multiple cerebral and cerebellar infarcts as the first clinical manifestation in a patient with Churg-Strauss syndrome: Churg-Strauss syndrome CSS is a rare autoimmune disease with small-vessel vasculitis. Neurological manifestation of CSS is common. Central nervous system is less frequently involved than that of peripheral nervous system. We report a case of year-old man who presented with acute onset of right hemiparesis and impaired cognition.

The presence of hypereosinophilia, asthma, sinusitis and extravascular eosinophil accumulation led to the diagnosis of Churg-Strauss syndrome. Brain magnetic resonance imaging MRI revealed multiple infarcts in bilateral cerebral and cerebellar hemispheres. The neurophysiology study did not reveal peripheral neuropathy. The patient was effectively treated with methylprednisolone, cyclophosphamide and warfarin.

Symptoms and signs of central nervous system can be the initial neurological manifestation of CSS patients. CSS should be considered while patients have stroke and hypereosinophilia. In our patient, there is a good response to timely steroid, immunosuppressant and anticoagulant therapies. Churg-Strauss syndrome and persistent heart failure: Churg-Strauss syndrome CSS is a rare small-vessel vasculitis typically associated with adult-onset asthma, peripheral and tissue hypereosinophilia, migratory pulmonary infiltrates, upper respiratory tract symptoms, and clinical evidence of systemic vasculitis.

Subsequently, the patient had remarkable improvement. Patient was then transitioned to azathioprine for 1. It may be difficult to determine myocardial disease activity status versus tissue damage in CSS with prolonged duration of heart failure symptoms. This is the first case report demonstrating that CSS cardiac disease may remain active despite 1 year of corticosteroid therapy, and significant improvement or remission can still be achieved by administering more aggressive cytotoxic immunosuppressive therapy. Optimal therapy and prospects for new medicines in eosinophilic granulomatosis with polyangiitis Churg-Strauss syndrome.

The prevalence of eosinophilic granulomatosis with polyangiitis EGPA; previously known as Churg-Strauss syndrome is lower than that of other antineutrophil cytoplasm antibody ANCA -associated vasculitides AAV's , and only a few randomized controlled trials have been conducted for this rare disease. However, recent international efforts have helped delineate the best treatment approach. A few biologic agents, including rituximab or mepolizumab, are now under investigation after interesting preliminary results. Treatment for EGPA still has several unmet needs.

Several biologic agents are now under investigation in randomized controlled trials, but a few others should be considered soon. Churg-Strauss syndrome or more accurately eosinophilic granulomatosis with polyangiitis EGPA is a small-vessel necrotizing vasculitis with a characteristic late-onset allergic rhinitis and asthma. The use of hospital morbidity database is an important element of the epidemiological analysis of this rare disease. The present study was undertaken to assess the incidence of EGPA and factors related to its epidemiology in Poland; the first analysis of the kind in Poland, enabling a comparison in the European context.

This is a retrospective, population-based study using hospital discharge records with EGPA diagnosis, collected for a National Institute of Public Health survey covering the period from to The group consisted of patients females and males with the first-time hospitalization for EGPA. A greater incidence of EGPA was observed in the regions with urban predominance.

We conclude that discharge records may be a useful element of epidemiological studies on EGPA. Eosinophilic myocarditis due to Churg-Strauss syndrome with markedly elevated eosinophil cationic protein. A year-old woman with asthma visited our hospital with increasing dyspnea and new-onset paresthesia and purpura in her legs. Physical examination showed a wheeze, pretibial edema, and surrounding purpura.

Chest X-rays showed cardiac decompensation and an electrocardiogram revealed a new ST-T change. Coronary angiography was normal.

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Cardiac magnetic resonance imaging implied diffuse myocardial edema and subendocardial late gadolinium enhancement. Skin biopsy of purpura showed superfi cial perivascular dermatitis with remarkable eosinophilic infiltrations. No evidence of drug allergies, parasitic infection, or myeloproliferative disorder was detected.

Based on these findings, a diagnosis of eosinophilic myocarditis due to Churg-Strauss syndrome was considered. Several markers of eosinophilic myocarditis and heart failure gradually improved, including ECP. She was discharged 30 days later with no cardiac event. Eosinophilic myocarditis is characterized by predominantly eosinophilic infi ltration.

Eosinophilic granule proteins, such as ECP and major basic protein, play important roles in the pathogenesis of eosinophilic myocarditis. We experienced a rare case of eosinophilic myocarditis due to Churg-Strauss syndrome. Markedly elevated ECP played an important role in the early diagnosis and subsequent reduction in ECP served as a marker of monitoring. In an asthmatic patient with dyspnea, hypereosinophilia, and vasculitis, Churg-Strauss syndrome with eosinophilic myocarditis should be considered.

Long term effectiveness of intravenous immunoglobulin in Churg-Strauss syndrome. To study the long term effectiveness of intravenous immunoglobulin and plasmapheresis associated with prednisone and cyclophosphamide in Churg-Strauss syndrome.

churg-strauss syndrome presenting: Topics by www.farmersmarketmusic.com

We studied 18 subjects with new onset Churg-Strauss syndrome. Clinical disease activity monitored by Birmingham vasculitis activity score BVAS and damage index modified Rankin score and functional C reactive protein, blood eosinophil count, and electromyogram-electoneurogram parameters were collected during treatment and the 3 year follow up period. Serum biomarkers are similar in Churg-Strauss syndrome and hypereosinophilic syndrome.

A reliable means of distinguishing between these groups of patients is needed, especially in the setting of glucocorticoid therapy. Serum biomarkers reported to be associated with CSS were measured using standard techniques. There were no differences between the subjects with definite or probable CSS or HES with respect to age, gender, or maintenance steroid dose.

Serum CCL17, IL-8, and eotaxin levels were significantly increased in eosinophilic subjects as compared to normal controls, but were similar between the eosinophilic groups. Serum CCL17 correlated with eosinophil count P presentation and biomarker profiles. This article is a U. Government work and is in the public domain in the USA. Results There were no differences between the subjects with definite or probable CSS or HES with respect to age, gender, or maintenance steroid dose.

Serum CCL17, IL-8 and eotaxin levels were significantly increased in eosinophilic subjects as compared to normal controls, but were similar between the eosinophilic groups. Serum CCL17 correlated with eosinophil count p presentation and biomarker profiles. A case of Churg-Strauss syndrome and central retinal artery occlusion with good visual recovery. The modern commode toilet and bedpan , used by bedbound or disabled persons, are variants of the chamber pot.

The term "potty" is used when discussing the toilet with small children, such as during potty training. It is also usually used to refer to the small, toilet-shaped devices made especially for potty training, which are similar to chamber pots. These "potties" are generally a large plastic bowl with an ergonomically-designed back and front to protect against splashes.

They may have a built-in handle or grasp at the back to allow easy emptying and a non-slip bottom to prevent the child from sliding while in use. Some are given bright colors, and others may feature gentle or unoffensive drawings or cartoon characters. In many cases they are used since it is difficult for children to maneuver themselves up onto the normal toilet; in addition the larger opening in the regular toilet is much too wide for a child to sit over comfortably and not fall in without some type of aid.

Their size means they can be packed away in a bag for days out or when camping with young children, and can be placed near or under beds for sufferers of nocturia or some other form of incontinence. Philippine mythology recounts that giving newlyweds a chamberpot assures them of prosperity. President Elpidio Quirino , as part of a smear campaign against him, was falsely rumoured to possess a golden arinola.

Thomas More in his satire Utopia had chamberpots made out of gold. From Wikipedia, the free encyclopedia. This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. She filled the royal council instead with nobles from her native Florence , including Concino Concini , the husband of one of her ladies in waiting, Leonora Dori , who served the superstitious Queen by performing exorcisms and white magic to undo curses and black magic. Concini became head of the royal council.

Marie de' Medicis decided to build a residence for herself, the Luxembourg Palace , on the sparsely-populated left bank. It was constructed between and , and modelled after the Pitti Palace in Florence. She commissioned the most famous painter of the period, Peter Paul Rubens , to decorate the interior with huge canvases of her life with Henry IV now on display in the Louvre.

She ordered the construction of a large Italian Renaissance garden around her palace, and commissioned a Florentine fountain-maker, Tommaso Francini , to create the Medici Fountain.

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Water was scarce in the Left Bank, one reason that part of the city had grown more slowly than the Right Bank. To provide water for her gardens and fountains, Marie de Medicis had the old Roman aqueduct from Rungis reconstructed. Thanks largely to her presence on the left bank, and the availability of water, noble families began to build houses on the left bank, in a neighborhood that became known Faubourg Saint-Germain.

In , she created another reminder of Florence on the right bank; the Cours la Reine , a long tree-shaded promenade along the Seine west of the Tuileries Gardens. Louis XIII entered his fourteenth year in , and was officially an adult, but his mother and her favorite, Concini, refused to allow him to lead the Royal Council. On April 24, , Louis had his captain of the guards assassinate Concini at the Louvre. Concini's wife was charged with sorcery, beheaded and then burned at that stake on the Place de Greve. Concini's followers were chased from Paris. Louis made his own favorite, Charles d'Albert , the Duke of Luynes, the new head of the council, and launched a new campaign to persecute the Protestants.

The Duke of Luynes died during an unsuccessful military campaign against the Protestants in Montauban. Louis tried several different heads of government before finally selecting the Cardinal de Richelieu , a protege of his mother, in April Richelieu quickly showed his military skills and gift for political intrigue by defeating the Protestants at La Rochelle in and by executing or sending into exile several high-ranking nobles who challenged his authority.

In , Marie de' Medici quarreled again with Richelieu, and demanded that her son choose between Richelieu or her. Marie de' Medici was exiled to Compiegne , then went to live in exile in Brussels, Amsterdam and Cologne, where she died in Richelieu turned his attention to completing and beginning new projects for the improvement of Paris. In , Richelieu began construction of a palatial new residence for himself in the center of the city, the Palais-Cardinal , which on his death was willed to the King and became the Palais-Royal. Other members of the Nobility of the Robe mostly members of government councils and the courts built their new residences in the Marais, close to the Place Royale.

Richelieu helped introduce a new religious architectural style into Paris, inspired by the famous churches in Rome, particularly the church of the Jesuits , and the Basilica of Saint Peter. Richelieu also built a new chapel for the Sorbonne , for which he had been the proviseur , or head of the college. It was constructed between and The dome was inspired by dome of Saint Peter's in Rome, which also inspired the domes at the churches of Val-de-Grace and Les Invalides.

The plan was taken from another Roman church, San Carlo ai Catinari. When Richelieu died, the church became his final resting place. The King and Richelieu became increasingly unpopular with the Parisians. The playwright and poet Pierre Corneille described the feelings of Parisians toward the King and his government in a sonnet written shortly after the King's death; "In his name, ambition, pride, audacity and avarice made our laws: Richelieu's successor, Cardinal Mazarin , decreed a series of heavy new taxes upon the Parisians to finance the ongoing war.

A new law in required those who had built homes close to the city walls to pay heavy penalties; in new tax was imposed on the middle-class to finance a loan to the state of , pounds, and taxes were imposed on all fruits and vegetables brought into the city. In , a new law required that those who had built homes on property officially belonging to the King would have to re-purchase the rights to the land.

In , Mazarin informed the noble members of three of the highest civil councils in the city, the Grand Council, the Chambre des comptes and the Cour des Aides that they would not be paid any salary for the next four years. These measures caused a rebellion within the Parlement of Paris , which was not an elected assembly but a high court made up of prominent noblemen.

Faced with the united opposition of the leaders of Paris, Mazarin backed down and accepted many of their proposals, and waited for an opportunity to strike back. An arranged a special mass at the Cathedral of Notre Dame, with the presence of the young King, to celebrate the victory, and brought soldiers into the city to line the street for the procession before the ceremony. As soon as the ceremony at Notre-Dame concluded, Mazarin had three prominent members of the Parlement arrested.

There were several violent confrontations in the streets between soldiers and the Parisians. The leaders of the Parlement were received at the Palais-Royal, where Anne of Austria and the young King were living, and she agreed, after some hesitation, to release the imprisoned member of the Parlement. This was the beginning of the Fronde , a long struggle between Mazarin and the Parlement of Paris and its supporters, and then between Mazarin and two princes of the royal family. The Parlement declared Mazarin a public enemy and called upon the Parisians to take up arms.

The Fronde quickly split into rival factions, while Mazarin did not have the funds to raise an army to defeat it. The standoff between Mazarin and the Fronde continued from until In , Mazarin made the error of enlisting seven to eight thousand German mercenaries with his own money to fight against the French army. He summoned the Parlement and leading merchants and clergy, and demanded to be recognized as the leader of the city.

On August 19 Mazarin withdrew to Bouillon in the Ardennes and continued his intrigues to win back Paris from there. Rising prices and the scarcity of food in Paris made the government of Frondeurs more and more unpopular. On September 24, a large demonstration took place outside the Palais-Royal, demanding the return of the King. On October 22 the young King, at the Louvre, issued a decree forbidding the Parlement of Paris to interfere in affairs of state and the royal finances. Mazarin, victorious, returned to Paris on February 3, and took charge once again of the government.

He moved his Paris residence from the Palais-Royal to the more secure Louvre: To make his intention clear Louis XIV organised a carrousel festival in the courtyard of the Tuileries in January , in which he appeared, on horseback, in the costume of a Roman Emperor, followed by the nobility of Paris. Inside the Louvre his architect Louis Le Vau and his decorator Charles Le Brun created the Gallery of Apollo, the ceiling of which featured an allegoric figure of the young king steering the chariot of the sun across the sky.

But another ambitious project, an exuberant design by Bernini for the eastern facade, was never built; it was replaced by a more severe and less expensive colonnade by Claude Perrault , whose construction proceeded very slowly due to a lack of funds. Louis turned his attention more and more to Versailles. On February 10, , Louis departed Paris and made his permanent residence in Versailles.

In the remaining forty-three years of his reign, he visited Paris just twenty-four times for official ceremonies, usually for no longer than twenty-four hours. While he built new monuments to his glory, the King also took measures to prevent any form of opposition to his will. On March 15, , he named Gabriel Nicolas de la Reynie to a new position, the Lieutenant General of Police, with the function of making the city work more efficiently, but also to suppress any opposition or criticism of the King.

The number of policemen was quadrupled. Anyone who circulated a pamphlet or flyer critical of the King was subject to whipping, banishment and a sentence to the galleys. On 22 October the King revoked the edict of Nantes and its promised religious tolerance for Protestants; on the same day demolition of the Protestant church at Charenton began.

Repression of dissident sects resumed. In his absence, his construction projects within Paris continued. Of the two hundred million livres that Louis spent on buildings, twenty million were spent in Paris; ten million for the Louvre and the Tuileries; 3. The city continued to expand. In , Colbert issued new lettres patent to enlarge the formal boundaries of the city to the site of the future wall built by Louis XVI in , the Wall of the Farmers General. The nobility built its townhouses in the Faubourg Saint-Germain, which expanded as far as Les Invalides.

Louis XIV declared that Paris was secure against any attack, and no longer needed its old walls. He demolished the main city walls, creating the space which eventually became the Grands Boulevards. To celebrate the destruction of the old walls, he built two small arches of triumph, Porte Saint-Denis and Porte Saint-Martin The last years of the century brought more unhappiness for the Parisians. In , the King's grand design to dominate Europe was challenged by the new Protestant King of England, William of Orange, King of England, and by a new coalition of European countries.

The war brought more taxation for the Parisians. In , the countryside was hit with poor harvests, causing widespread hunger in the city. The bread was sold for two sous a loaf at the Louvre, the Place des Tuileries, the Bastille, the Luxembourg Palace, and on rue d'Enfer. Crowds pushed and fought for a chance to buy bread. The terrible conditions were repeated in the winter of Paris in was roughly round, about five hundred hectares in area, and was divided by the Seine. It was possible to walk at a brisk pace from the north end of the city to the south, a distance of about three kilometers, in about half an hour.

Between the main streets in the center of the city was a maze of narrow, winding streets, between wooden houses four or five stories high, dark at night and crowded and noisy during the day. At night, many of the streets were closed with large chains, kept in drums at the corners. They were dimly lit by a small number of oil lamps. The commercial center of the city was the river port, located mostly on the right bank between the Place de Greve and the Quai Saint Paul, not far from les Halles, the central market of the city. The colleges of the University occupied buildings on the side of Mount Saint-Genevieve, on the left bank.

The wall was four meters high and two meters thick, and was reinforced by fourteen bastions ranging in size from 30 to meters, and by a moat 25 to 30 meters wide, which was always kept full of water. Access to the city was by fourteen gates, each of which had a drawbridge over the moat. The gates were closed at night, usually between seven in the evening and five in the morning, with the schedule changing depending upon the season.

The left bank did not have any recent fortifications; it was still protected by the old wall of King Philip Augustus. The city wall did not mark the real edge of the city; there were some rural areas, with gardens and orchards, inside the walls, and there were many buildings and houses outside. The Faubourg of Saint-Jacques also on the left bank, was largely occupied by monasteries. The edges of the growing city were not clearly defined until , when the royal government drew a new line, which included the Faubourgs on both the right and left banks. On the left bank it reached south as far as the site of the future observatory, and included the all the area of the modern fifth and sixth arrondissements.

On the right bank, the new boundary followed the line of new fortifications constructed by Louis XIII, along the modern boulevards de la Madeleine, des Capucines, des Italiens, Montmartre and Poissonniere. In , Louis XIV declared that France was safe from attack and the walls were no longer necessary, and they were gradually replaced by boulevards lined by trees.

The area of the city approximately doubled from what it had been early in the century, from to about hectares. In , the administrators marked the border more precisely, planting thirty-five marble or cut stone pillars and markers, twenty-two on the right bank and thirteen on the left. On the right bank, it began at the Place de la Concorde, passed by the sites of future Gare du Nord and de l'Est and reached almost to the modern avenue de la Republique and Place de la Nation, and came back to the river again at Bercy. On the left bank, the edges of the city were at rue de Tolbiac to the east and close to the modern Pont d'Alma to the west.

There was no official census of the city's population in the 17th century, but, using tax records, the amount of wheat consumed and church baptism records, modern historians estimate that it increased from about , in to , in to about , in about An account published in by Lemaire estimated that there were 23, houses in Paris, each inhabited by an average of twenty persons.

Paris society was structured in a formal and rigid hierarchy. They were subdivided into four categories; the highest were the titled nobility, gentlemen of the royal chamber and marshals of France, who had the titles of duke, marquis, comte , and baron. Just below them were those with the lesser rank of chevalier or seigneur. The third level of nobles who held their title because of their function, as members of the highest bodies of state, the Parlement of Paris, the Grand Council, the Chambre des comptes , and the Cour des Aides.

They were known as the Noblesse de la Grand Robe , the high nobility of the robe, because of the ceremonial costumes they wore. They usually purchased their titles, but once acquired they became hereditary. Below them were nobles of the petit robe , with high positions in the less important government bodies and less impressive ceremonial costumes. Below them, at the lowest edge of the nobility, were the ecuyers ; some were from the ancient nobility, but many more recent arrivals, who had purchased a title or position at court. Just below the nobles and ecuyers but above the bourgeois were the notables , who were largely officials in the lesser government structures; officials in the treasury, royal accountants, and lawyers at the Parlement or other high courts.

The notables but included prominent doctors and a few highly successful artists, including Claude Vignon and Simon Vouet. At the top were the Honorable hommes , a category which included the most successful merchants, artisans who had ten or fifteen employees, and a considerable number of successful painters, sculptors and engravers.

Below them were the marchands or merchants, successful members of all the different professions. Twenty percent had their own shops. They usually lived in a single room, and were often not far above poverty. Below the craftsmen and artisans was the largest class of Parisians; domestic servants, manual workers with no special qualifications, laborers, prostitutes, street sellers, rag-pickers, and a hundred other trades, with no certain income.

They lived a very precarious existence. A large number of Parisians were elderly, sick, or unable to work because of injuries. They were the responsibility of the Catholic church in each parish; an official of the parish was supposed to keep track of them and provide them with a small amount of money.

In times of food shortages, such as the famine of , or epidemics, the church was often unable to take care of all of the needs of those in the parish. In the case of vagabonds, those who came to Paris from outside the city but had no profession or home, there was no structure to take care of them. There were a very large number of mendiants , or beggars, on the streets of Paris. There was an outbreak of bubonic plague in the city in , and there were frequent cases of leprosy , tuberculosis and syphilis in Paris. The Parisians learned that Geneva, Venice, Milan, Antwerp and Amsterdam had chosen to confine their beggars in hospitals created for that purpose.

In , the Bureau of the City ordered that the vagabonds should be taken off the streets. Those who could not show they were born in Paris were required to leave the city. Those who were native Parisians were put to work. When the news of the decree spread, many of the vagabonds and beggars quickly departed the city. The police rounded up the rest, confined the men who were able to work in a large house in the faubourg Saint-Victor, and the women and children in another large house in faubourg Saint-Marcel. Those with incurable illnesses or unable to work were taken to a third house in the faubourg Saint-Germain.

They were supposed to awake at five in the morning and to work from 5: The work consisted of grinding wheat, brewing beer, cutting wood, and other menial tasks; the women and girls over the age of eight were employed by sewing. The city judged the program a success, and acquired three large new buildings for the beggars. But within four years the program was abandoned; the work was poorly organized, and many of the beggars simply escaped.

Renaudot, a Protestant and a physician, founded the first weekly newspaper in France, La Gazette in Based on the newspaper, he founded the first employment bureau in Paris, matching employers and job-seekers. He organized public conferences on topics of public interest. He also organized the first free medical consultations for the poor. This put him into opposition with the medical school of the University of Paris, which denounced him. After the death of his protectors, Richelieu and Louis XIII, the University had his medical license taken away, but eventually the University itself began to offer free medical consultations to the poor.

Another pioneer in helping the Paris poor during the period was Vincent de Paul. As a young man, he had been captured by pirates and held as a slave for two years. When he finally returned to France, he entered the clergy and became chaplain to the French prisoners in Paris sentenced to the galleys. He persuaded wealthy women from noble families to prepare and distribute meat broth to the patients, and to help the patients with their needs. He instructed the women visiting the hospital to dress simply, and to speak to the poor with "humility, gentleness and cordiality.

The young women, dressed in gray skirts and white cornettes , carried pots of soup to the poor of the neighborhoods. The first house of the order was at La Chapelle. Between and , eight more houses of the order were opened to serve food to the poor. Four hundred unwanted babies were abandoned each year at the maison de la Couche, or maternity hospital, where most died in a very short time. There was only one nurse for four or five children, they were given laudanum to keep them from crying, and they were often sold to professional beggars, who used them to inspire pity and donations.

In , he persuaded wealthy Parisians to donate money to establish a home for found children on rue des Boulangers, near the porte Saint-Victor. De Paul and the sisters of the order made visits to churches to bring babies abandoned there at night to the new home. His work came to the attention of the King and Queen, who provided funding in to build a large new home for abandoned children near Saint-Lazare.

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