The major clinical manifestations of Churg–Strauss syndrome (CSS) include asthma, hypereosinophilia and the extrapulmonary manifestation of systemic vasculitis.1 The involvement of the central nervous system (CNS) is less common (<10%), with significant morbidity and mortality in affected patients.2 Glucocorticoids combined with cyclophosphamide represent the treatment of choice in patients with severe involvement of the heart, nervous system or kidney.3 In the case of intolerance to cyclophosphamide, plasma exchange, interferon and mycophenolate mofetil (MMF) have been suggested as alternatives.4 A few case reports on the use of rituximab in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis and CSS are available5,–,7; however, none reported on patients with …