A 35 year old man has been given a dx of allergic rhinitis and asthma. Exam: peripheralare present in the form of tender subcutaneous nodules. The patient is responding well to corticosteroids. What is the single most appropriate diagnosis?

The key is B. Churg-strauss syndrome. [The American College of Rheumatology has identified six

criteria for the diagnosis 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].