A case of asthmatic granulomatosis

Severe asthma (SA) is a pressing problem in respiratory diseases and accounts for 3–10% of all asthma cases. It is increasingly recognized that SA consists of multiple heterogeneous phenotypes and their histopathology, especially in the distal airways and interstitium, remains poorly understood. Transbronchial biopsy with video imaging and histologic examination allow the detection of various changes, including cases associated with granulomatous inflammation in addition to eosinophilic infiltrates. In the presented clinical case of a patient with severe eosinophilic bronchial asthma in the absence of autoimmune diseases, transbronchial biopsy with further histologic examination of the biopsy specimen revealed eosinophilic granuloma in the form of polyp-like masses in the lung tissue and walls of small bronchi. The cellular composition of the granuloma was represented by macrophage elements, a cluster of lymphocytes with an admixture of eosinophils, individual plasma cells, fibroblasts and capillary vessels with clusters of eosinophils. The treatment (baseline and anti-IL5 therapy), in addition to achieving complete control of asthma symptoms, reduction of nasal congestion, reduction of blood eosinophils, FENO, led to the disappearance of polyposis eosinophilic formation in the bronchial mucosa. Such pathology is described in the literature as “asthmatic granulomatosis” and is of interest for further studies.

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