We report the case of a 65-year-old woman who presented with Churg-Strauss syndrome (CSS) associated with multiple cerebral infarcts. Four years ago, she was diagnosed as having CSS based on asthma, hypereosinophilia and peripheral neuropathy, and corticosteroid therapy achieved a remission. However, she showed exacerbation of asthma and hypereosinophilia during the tapering schedule of steroid, and she was hospitalized because of dizziness and mild left side weakness. Analysis of blood chemistry detected significant hypereosinophilia (13,730/μl), increased blood-coagulating activity, elevated NT-proBNP concentration and renal dysfunction. MRI of the brain revealed multiple small infarcts in cortex and the watershed area. The patient was diagnosed with exacerbation of CSS, and treatment with increased dose of corticosteroid induced a clear improvement in symptoms, with decrease of the eosinophilia and a clear improvement of the renal function. The hypercoagulable state and direct eosinophil toxicity may contribute to strokes in hypereosinophilic condition of CSS. This case was remarkable for illustrating multiple cerebral infarctions in CSS. CSS should always be considered in patients with hypereosinophilia and stroke.
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