1. Case presentation

2. 59 CC: 5 PI:1PTA URI symptom 5PTA . 3PTA . . 3. Past Hx :2PT . 10PTA - 4. Physical examination BT 38 cPR 100/min BP 120/80 mmHg RR 24/min Conscious, not pale, no malar rash, no oral ulcerLN -ve skin :hyperpigmented scar with hemorrhagic crust both forearms and legs lung :clear, equal BS heart:regular, normal s1s2,no murmur abd:soft, not tender, no mass,no hepatosplenomegaly neuro: pupil 3 mm RTL BE, decrease motor tone all extremities 5. Motor: Rt. Lt.DTRRt.Lt. deltoidIV IV bicepsIII+IV01+ tricepsIII+II 01+ wrist EX/FLEXIV/II0/000hip E/FIV/IIIV/IV knee E/FV/IIIV/III02+ ankle E/FV/IIV/I01+ Sensory: impaired both hand and feet above ankle BBK: plantar flexion Propioception: impaired 6. Problem list

Acute Symmetrical weakness

Hx of asthma

Hx recurrent pruritus

7. Laboratory CBC:wbc 21,950Hct 35plt 277,000 N 42.5, L 12.3, Mo 3.4, Eo41.7 normochromic normocytic Rbc UA:sp.gr. 1.015, prot/sugar ve, Wbc 0-1,Rbc 0-1 FBS147,BUN 5,Cr 0.39 E lyteNa126,K 3.4,Cl 82,CO2 25,Ca 2 +9.1 LFTAlb 4.0,Glob4.0, AST 55,ALT 59,Alk 185 CPK356 ESR77 8. LaboratoryANA HT,chorea,seizures, testicular pain

Few pathology report

Steroid is standard Rx

62. LTRAvsCSS 63.

Since 1999-2009

Conflict data

Difficult to research design

What is hypothesis for LTRA induce CSS ?

64. 65. 66. 67. 68. 69. 70. 71. LTRA ICS SABA LABA 72. 73. 74. 75. Quiz

Which of the following is not criteria for Dx CSS in ACR criteria?

1. asthma

2. eosinophillia > 10%

3. systemic vasculitis

4. paranasal sinus abnormality

5. neuropathy

76.

Which HLA may be associated with CSS ?

1. HLA-B27

2. HLA-DRB4

3. HLA-C

4. HLA-DR2

5. HLA-DR3

77.

All the following are poor prognostic factor for CSS except_______

1. nephrotic range proteinuria

2. renal failure

3. GI involvement

4. mononeuritis multiplex

5. cardiomyopathy

78.

Subgroup of CSS is differentiate by ANCA status, which one is not clinical of ANCA +ve patient ?

1. cardiomyopathy

2. small vss. Vasculitis

3. glomerulonephritis

4. pulmonary hemorrhage

5. purpura

79.

Which one of the following is true in childhood CSS ?

1. incidence of CSS is similar between

children and adult

2. ANCA +ve 50% of case

3. usually require 2 ndline Rx

4. HT is common problem in childhood CSS

5. pathogenesis of CSS in chlidren differ

from adult

80.

female 52 yrs Hx asthma 20 yrs on ICS , monteleukast,present with progressive dyspnea on intermittent short course oral steroid

PE wheezing and crackle both lung no clubbing

CBC wbc 10200 Eo 23 % skin test alternaria , aspergillus +ve

ESR 70IgE 500CXR bilateral parenchymal infiltrationCTchest peripheral airspace subpleural consolidationWhat is diagnosis ?

1. CSS

2. chronic eosinophillic pneumonia

3. usual interstitial pneumonia

4. ABPA

5. Idiopathic eosinophillic syndrome

81. Take home messege

Clinical manifestration of CSS

Pathogenesis is unknown

CSS in children

LTRA and CSS association

Further research direction

82. THANK YOUFORYOUR ATTENTION 83. 84. Differential diagnosis 1.29 85. 1.13