Churg-Strauss Syndrome?

[Carolina03]

Hi,

I was diagnosed with asthma/chronic bronchitis and microvascular disease after my third pregnancy in 2004 in which I experienced periodic chest pain. I'm under the care of a cardiologist and pulmonologist.

A GI-doctor is working me up for moderate abdominal pain over the ileum. He suspects Crohns; my blood work was abnormal for inflammation and eosinophils. My ESR was normal. If it matters, I had the test during prednisone therapy for severe bronchitis.

My primary care doctor has recommended referring me to a rheumotologist for evaluation of vasculitis but I am tired of doctors.

What do you think of Churg-Strauss Syndrome or another type of vasculitis, (does anything come to your mind)?

And do your young female patients tend to be more symptomatic around their periods?


Thanks,
C

[Kevin Pho, MD]

It is difficult to say without evaluation.  If Churg-Strauss syndrome is consider, one can consider various blood tests for evaluation - including ANCA antibodies.  

If there is suspicion of Crohn's, more antibody testing can be considered (i.e. the anti-OmpC) as well as imaging with a small-bowel follow-through or capsule endoscopy.  

As for symptoms around the menstrual period - it is possible that various non-specific symtoms can be amplified around that time.  

A rheumatology referral is a reasonable suggestion.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b

[myproblem]

RE: "My ESR was normal. If it matters, I had the test during prednisone therapy for severe bronchitis."

This would definately make a difference. You should repeat that test with no prednisone or other anti-inflamatories.

[Carolina03]

PS Oops, my ESR was high (15) but not dramatically.

Re: my last question on increased symptoms of chest pain at the beginning of my menstrual cycle. It's as if a switch goes "on" and the chest pain returns with a vengeance. My GYN sent me to my cardio and said it could be related to edema. When I brought it up with my cardio, he shrugged. I swear.

I know science isn't clear cut. But it seems to me if you have a predictable, debilitating and seemingly dangerous symptom, there ought to be a standard of care to treat it. I can't take hormones due to cardio disease.

[Carolina03]

Thanks re: the ESR advice. I'll bring it up with my doc.

[Carolina03]

Thanks, Dr. Pho. Geez, talk about Internet time!