Leukotriene receptor antagonists and Churg-Strauss Syndrome: an association with relevance to dermatopathology?

摘要

It may seem unusual to have this month's journal reviews focus on journals such as Seminars in Respiratory Critical Care, Pharmacoepi-demiology and Drug Safety, and Clinical Rheumatology, but given a recent chance encounter of a skin biopsy with a granulomatous vasculitis with eosinophils from a pediatric patient on montelukast, I felt the topic warranted discussion. Over the years, it has been controversial whether there is a, causal relationship between leukotriene receptor antagonists (LTRA) and Churg-Strauss Syndrome (CSS) or whether the concommitant withdrawal from corticosteroids is responsible for unmasking the syndrome. C SS is rare in adults and even rarer in children, which confounds the process of determining causality. The use of LTRA within the general population is not uncommon and it is yet unclear whether the incidence of CSS is increasing or whether recent awareness of a possible association may be inducing a reporter bias. As LTRA are being considered for other conditions, the future recognition of biopsy specimens with features of CSS will be important, particularly within the pediatric population, as any detectable increase in incidence within this population subset will yield information on the strength of the association. To our knowledge, the phenomenon of CSS in patients on leukotriene receptor antagonists has not been reported in the dermatopathology literature; it does exist and perhaps with this month's journal reviews, we may all become familiar with the possibility and remain particularly vigilant with respect to the pediatric population.