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Churg-Strauss syndrome is also known as allergic granulomatosis,and it is a rare systemic vasculitis that may affect multiple organ systems, and particularly the lungs. A 42-year-old woman with Churg-Strauss syndrome underwent endoscopic sinus surgery under total intravenous anesthesia with propofol and remifentanil. Anesthesia was performed uneventfully, but there were several issues of concern that evolved regarding the perioperative management of a patient with this syndrome.