Eosinophilic granulomatous vasculitis

Antithyroid drugs, especially propylthiouracil, can be associated with the development of antineutrophil cytoplasmic antibody (ANCA)-positive vasculitis, often manifesting as renal disease. Atypical presentations, with pulmonary capillaritis (58) and lupus-like syndrome (59), have been described in individual cases. Furthermore, two cases of vasculitis have been associated with carbimazole, one presenting with eosinophilic granulomatous vasculitis localized to the stomach (60) and another with p-ANCA positive vasculitis causing simultaneous acute renal insufficiency and massive pulmonary hemorrhage (61). 

Seve P, Stankovic K, Michalet V, Vial T, Scoazec JY, Broussolle C. Carbimazole induced eosinophilic granulomatous vasculitis localized to the stomach. J Intern Med 2005 258(2) 191-5. 

Immunological reactions to cromoglicate can involve the pericardium, the lung, the eye, the nasal mucosa, the skin, the joints, and the liver. Rarely, a hypersensitivity reaction can cause fever (4). A survey of the world literature up to 1982 found 13 cases of facial rash, urticaria, and/or generalized dermatitis, and one of nasal congestion. In 19 patients there was bronchospasm and/or pulmonary edema, eventually culminating in shock. Four cases of eosinophilic or granulomatous pulmonary infiltration, one of liver disease and vasculitis, one of pericarditis, and three of polymyositis were reported. 

Eosinophil-rich and granulomatous inflammation involving the respiratory tract and necrotizing vasculitis affecting small- to medium-sized vessels, and associated with asthma and blood eosinophilia... 

According to the Chapel Hill Consensus Conference on the nomenclature of systemic vasculitis (84), CSS belongs to the group of antineutrophil cytoplasmic antibodies (ANCA)-associated smaU-vessel vasculitis and is defined as an eosinophil-rich and granulomatous inflammation involving the respiratory tract, with necrotizing vasculitis affecting small- to medium-sized vessels, and associated with asthma and eosinophiha. 

The vasculitis is similar to that of classic polyarteritis nodosa. The characteristic histopathological features are granulomatous reactions, vdiich are present in the tissues or even within the vessel walls. These are usually associated with infiltration of the tissues with eosinophils. 

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