(Allergic granulomatous angiitis, eosinophilic granulomatosis with polyangeitis) 

Rare (1/100,000). Sporadic, likely of autoimmune origin. Systemic disease that combines asthma, transient pulmonary infiltrates, hypereosinophilia, and vasculitis involving many organs (lungs, heart, eyes, CNS, gastrointestinal tract, skin). More common in asthmatic patients: intake of leukotrienes receptor antagonists could be a contributing factor. Onset after 15 years of age.

Its evolution usually follows 3 successive phases:

-        prodromal: asthma with or without allergic rhinitis

-        steady-state phase: blood and tissue eosinophilia (pneumonia or eosinophilic gastroenteritis)

-        vasculitis (skin damage in 2/3 of cases).

Cardiac involvement (coronary heart disease, rhythm disturbances, heart failure, cardiomyopathy) is of poor prognosis.

Diagnostic criteria of the American College of Rheumatology: presence of 4 of the 6 following: asthma, eosinophilia > 10 %, neuropathy, pulmonary infiltrates, paranasal sinus abnormalities and eosinophilic vasculitis.

Treatment: mepolizumab (anti-TL5) subcutaneously once every 4 weeks. Corticosteroid therapy with high-dose immunosuppression in case of failure.

Anesthetic implications: 

echocardiography; hyperreactivity of the airways; side effects of corticosteroid therapy or immunosuppression

References : 

• Chung KY, Kim HK, Yoon JY, Kim WS. 
  Cholecystectomy of a patient with Churg-Strauss syndrome. 
  Korean J Anesthesiol  2010; 57: 749-53. 
• Sato H, Shimoda O, Terasaki H. 
  Anesthetic management of a patient with the allergic granulomatous angeitis (Churg-Strauss syndrome).
  Masui 1998; 47: 1114-7.

Updated: June 2022