Churg–Strauss syndrome (CSS) is a rare vasculitic disorder that generally occurs in patients with bronchial asthma. CSS is
being increasingly recognized in asthmatic patients treated with leukotriene receptor antagonists. However, the nature of
this relationship remains to be elucidated. The present report describes three asthmatic patients who developed clinical manifestations
highly suggestive of CSS, although one patient lacked the presence of eosinophilia. The patient, however, exhibited biopsy-proven
cutaneous necrotizing vasculitis, which improved after withdrawal of montelukast. The second patient presented with systemic
constitutional signs including fever, malaise, arthralgias, clinical jaundice, peripheral blood eosinophilia, and biopsy-proven
eosinophilic hepatitis. The third patient also had circulating eosinophilia, scleritis, and arthritis. All patients improved
after discontinuation of the leukotriene receptor antagonist (montelukast).
Keywords Churg–Strauss - Eosinophilia - Hepatitis - Necrotizing vasculitis - Scleritis - Vasculitis