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Rheumatology 2002; 41: 535-539
© 2002 British Society for Rheumatology

Original Papers

Churg–Strauss syndrome in two patients receiving montelukast

P. Guilpain, J.-F. Viallard1, P. Lagarde2, P. Cohen, M. Kambouchner3, J.-L. Pellegrin1 and L. Guillevin

Department of Internal Medicine, Hôpital Avicenne, Assistance Publique, Hôpitaux de Paris, Université Paris-Nord UPRES EA 3409, 125 route de Stalingrad, 93009 Bobigny Cedex,
1 Department of Internal Medicine, Hôpital Haut-Lévêque, avenue de Magellan, 33604 Pessac Cedex,
2 Department of Internal Medicine, Centre Hospitalier de Lagny, Marne-la-Vallée, 31 avenue du Général-Leclerc, 77405 Lagny Cedex and
3 Department of Pathology, Hôpital Avicenne, Assistance Publique, Hôpitaux de Paris, Université Paris-Nord, 125 route de Stalingrad, 93009 Bobigny Cedex, France

Objective. Churg–Strauss syndrome (CSS) has been described in association with the treatment of asthmatic patients with leukotriene receptor antagonist. The main mechanism proposed to explain this condition is the unmasking of CSS after the leukotriene receptor antagonist has allowed corticosteroid tapering. Other hypotheses might be proposed.

Methods. We describe two patients who developed CSS after starting treatment with montelukast, a new antileukotriene drug.

Results. Both patients presented with CSS after 4–5 months of treatment with montelukast. Neither patient received long-term systemic steroids for asthma, but both were on inhaled steroids. One patient had a myocardial involvement and experienced a stroke. Our two patients were treated with systemic steroids and cyclophosphamide.

Conclusions. CSS does not appear to relate to steroid tapering in our patients. The other hypotheses are a coincidence or a direct adverse effect of the antileukotriene. Long-term data on these drugs are lacking and leukotriene's role in vasculitis remains to be elucidated.

KEY WORDS: Churg–Strauss syndrome, Montelukast.

Correspondence to: L. Guillevin.


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