Mr. Shi came to Beijing from abroad to see an asthma doctor and said that he had been using Sulidex (a combination of inhaled hormone and long-acting bronchodilator) for more than 3 years, which worked well at first, but recently he had recurrent attacks and had to take oral hormones, which would come back when he stopped taking them. He also said he had a “deviated nasal septum” and had surgery, and then he had a “rhinitis” and used nasal spray hormones frequently. I don’t know how it happened, but in recent weeks, he had frequent “stomach pains” that didn’t seem to be related to diet, and nothing was found in the local hospital. In general, inhaled hormones combined with long-acting bronchodilators can bring most asthma under satisfactory control. However, the recurrence of Mr. Shi’s disease without any obvious triggering factors with continued medication required a careful search for the cause. Further examination revealed that his peripheral blood eosinophil count was as high as 33% (normal does not exceed 5%) and total IgE reached 1400 IU/ml (our normal value <87). Gross observation of the colonoscopy did not show any significant abnormalities, but the mucosal biopsy revealed eosinophilia, consistent with eosinophilic enterocolitis. At this point, the diagnosis was relatively clear. Allergic vasculitis with granulomatosis, also known as Churg-Strauss syndrome, is a relatively rare form of systemic small vessel vasculitis that presents with systemic symptoms, including upper respiratory tract (rhinitis, sinusitis), skin, nervous system, digestive system, and heart, in addition to asthma and pulmonary manifestations. Unlike other types of small vessel vasculitis, the disease rarely affects the kidneys, but a higher percentage of the digestive tract is involved. Laboratory tests with significantly elevated peripheral blood eosinophil counts and total IgE are suggestive of the diagnosis; positive peripheral blood anti-neutrophil antibodies (ANCA) contribute to the diagnosis. Treatment of the disease requires oral glucocorticoids, which can be combined with immunosuppressants if necessary. The prognosis is generally good if treatment is timely and standardized. Follow-up on September 29, 2010: After standardized oral hormone therapy, asthma was completely controlled, abdominal pain disappeared, and lung function returned to normal on recheck. The peripheral blood eosinophil count decreased to less than 1% and the total blood IgE decreased to 230 IU/ml. Since the external CT showed exudative shadows in both lungs in August, the results of this review showed that the lung shadows completely disappeared (attached picture).