A 75 year old man presents with Bell’s palsy. His past medical history is significant for late rash previously. CXR shows multiple soft shadows and CBC eosinophilia. What is the single most likely positive antibody?

The key is A. p-ANCA. [The dx is Charg Strauss Syndrome (CSS). There are six criteria for dx of CSS:

Asthma (wheezing, expiratory rhonchi).

Eosinophilia of more than 10% in peripheral blood.

Paranasal sinusitis.

Pulmonary infiltrates (may be transient).

Histological confirmation of vasculitis with extravascular eosinophils.

Mononeuritis multiplex or polyneuropathy.

The presence of four out of six of these features has a high specificity and sensitivity for the

diagnosis of CSS.

In the given case there are 1. Bell’s palsy (mononeuritis multiplex) 2. Asthma 3. Multiple soft

shadows on CXR (pulmonary infiltrates) 4. Eosinophilia. Presence of these 4 features are

diagnostic of CSS. In CSS 70% patient is p-ANCA positive!].