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Sep 2012, Vol 130, No. 9 >

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Research Letters | Sep 2012

Conjunctival Granulomatosis in Churg-Strauss Syndrome

Elisabeth M. Messmer, MD, FEBO; Christina V. Miller, MD; Anselm Kampik, MD, FEBO
Arch Ophthalmol. 2012;130(9):1228-1229. doi:10.1001/archophthalmol.2012.83.
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Churg-Strauss syndrome (CSS) is a rare, potentially lethal systemic vasculitis characterized by necrotizing arteritis, eosinophil infiltration of the tissues, and extravascular granulomas.1 Ocular involvement includes orbital inflammation, scleritis or episcleritis, peripheral ulcerative keratitis, uveitis, anterior ischemic optic neuropathy, retinal artery and vein occlusions, choroidal ischemia, and oculomotor nerve palsies. Conjunctival involvement is rare and can present as nonspecific conjunctivitis, inflammatory thickening of the conjunctiva with or without amyloidosis, or conjunctival nodule with inflammation.2- 5 We describe a patient with clinically inactive CSS who developed multiple bilateral conjunctival nodules.
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Figure 1. Yellowish nodular lesions in the bulbar conjunctiva of the right eye of a 38-year-old woman with treated Churg-Strauss syndrome.

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Figure 2. Histologic findings. A, Conjunctival granuloma formation involving lymphocytes, macrophages, eosinophils, and a central necrosis (hematoxylin-eosin, original magnification ×10). B, Immunohistochemistry confirmed the presence of CD3+ T lymphocytes, CD68+ macrophages (not shown), and CD20+ B lymphocytes (not shown) (original magnification ×10). C, The conjunctival stroma showed a vast amount of eosinophils in the tissue (arrowheads) (immunohistochemistry, original magnification ×40). D, The conjunctival stroma also showed pronounced occlusive perivasculitis (asterisks), with the perivascular infiltrate mainly confined to arteries and consisting of CD3+ T lymphocytes, CD20+ B lymphocytes, histiocytes, and giant cells (immunohistochemistry, original magnification ×40).

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