Rheumatology

	Answer 6 CSS. This patient presents with the classic findings of CSS, including allergic rhinitis, asthma, and eosinophilia. The eosinophilia affects different organ systems, causing inflammation. The lungs, peripheral nerves, sinuses, and skin are most commonly involved; however, cardiovascular, renal, gastrointestinal, and the central nervous systems can also be affected. The patient’s neurologic manifestations are likely due to mononeuritis multiplex. The 3 phases of CSS are the (1) prodromal phase, where asthma predominates; (2) the eosinophilic phase, in which eosinophils dramatically increase and pulmonary manifestations become evident; and (3) the vasculitic phase, in which nonspecific findings such as weight loss, fevers, fatigue, and skin lesions predominate. Dermatologic manifestations include a combination of macular papular rashes, subcutaneous nodules, palpable purpura, and raised erythematous lesions. In eosinophilia-myalgia syndrome, the blood eosinophil count is greater than 1000 cells/µL and patients have incapacitating myalgia and no evidence of infection or neoplastic conditions. Several cases of eosinophilia-myalgia syndrome have been attributed to the consumption of products containing ι-tryptophan. Pulmonary sarcoidosis is a progressive granulomatous disorder with variable findings on radiography depending on the stage of disease (stage 1, bilateral hilar lymphadenopathy; stage 2, hilar lymphadenopathy; stage 3, parenchymal disease without hilar lymph nodes; stage 4, pulmonary fibrosis). Common symptoms of pulmonary sarcoidosis include cough, dyspnea, and exercise limitation but not marked eosinophilia. Bronchopulmonary aspergillosis is an allergic lung reaction to a type of fungus (most commonly Aspergillus fumigatus) that occurs in some individuals with asthma or cystic fibrosis, causing cough and wheezing and sometimes fever. This condition is not associated with neurologic sequelae. Click here to return to the questions
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