churg-strauss vasculitis with gastrointestinal manifestations during tapering of prednisolone

a 56-year-old woman came in with abdominal pain, nausea, vomiting, fever, 15 kg weight loss and accelerated asthma for which she had used zafirlukast and a high dose of prednisolone. during taper down of her prednisolone, her condition deteriorated. she developed generalized wheezing, diffuse abdominal pain, and left foot drop. lab examination revealed eosinophilia, elevated red cell sedimentation rate and positive p-anca. considering her asthma, involvement of her sinuses apparent on paranasal sinus computed tomography, development of mononeuritis multiplex and her lab findings, the diagnosis of churg-strauss vasculitis was made. high dose prednisolone and endoxane pulse therapy were started. after 3-4 days, her fever and other symptoms resolved dramatically. after three months of follow-up, she is doing well on maintenance therapy and had no symptoms. this syndrome may develop during tapering of prednisolone in those who use leucotrienes.