Clin Drug Invest 2003; 23 (5): 347-350 CASE REPORT 1173-2563/03/0005-0347/$30.00/0 © Adis Data Information BV 2003. All rights reserved. Wegener’s Granulomatosis after Treatment with Montelukast in a Patient not Receiving Systemic Corticosteroid Treatment Aliye Candan Ogus, Aykut Cilli, Tulay Ozdemir and Gulay Ozbilim Department of Chest Medicine, Akdeniz University Medical Faculty, Antalya, Turkey Contents 1. Case Report ............................................................................. 347 2. Discussion ............................................................................... 349 Leukotriene antagonists are the first new class of 1. Case Report drugs for the treatment of asthma in more than 20 A 62-year-old woman presented with cough, years. These drugs include one enzyme inhibitor of blood-streaked sputum, dyspnoea, fever up to 5-lipoxygenase (zileuton) and three chemically dis- 39.8°C and migratory polyarthralgia. She had had tinct cysteinyl leukotriene type-1 receptor antagon- dyspnoea and cough continuously for 4 days and ists (zafirlukast, pranlukast and montelukast). The fever for 1 day. Her past medical history was re- greatest concern raised during treatment with cys- markable for a 2-year history of asthma that had teinyl leukotriene receptor antagonists is the devel- been followed up by our department. Results of her opment of Churg-Strauss syndrome (CSS). [1,2] The spirometric reversibility test were compatible with causal role of these drugs in the development of CSS asthma. She had received inhaled budesonide (800 μg/day) and formoterol (24 μg/day) on a regular has not been completely clarified. [3] It has been basis and terbutaline as needed for her asthma for postulated that the induction of CSS is not due to almost 1 year. She had not received systemic corti- direct effects of leukotriene antagonists, but rather costeroid treatment for at least the last 5 months. She indicates the emergence of an underlying disease had developed hoarseness due to budesonide ther- because of the withdrawal of corticosteroids. [1,4] apy 20 days earlier. Inhaled corticosteroids were In this report, we describe the case of an asthmat- discontinued and oral montelukast (10 mg/day; ic patient who developed Wegener’s granulomatosis Singulair,  Merck Sharp Dohme, Cramlington, while receiving montelukast therapy. She had not UK) 1 was started. Ten days before admission she received systemic corticosteroids. To the best of our noticed a migratory polyarthralgia in her ankles, knowledge, this is the first report of a case of knees, shoulders, wrists and interphalangeal joints. Wegener’s granulomatosis that was associated with She also noted a rash and swelling in her wrists and leukotriene antagonist therapy. knees. Each arthralgia attack lasted 2–3 days and 1 The use of tradenames is for product identification only and does not imply endorsement.