A 32-year-old atopic woman presents with bilateral nasal polyps, recurrent pansinusitis, and episodic severe bronchospasm triggered by aspirin use. Nasal smear shows numerous eosinophils. What is this syndrome called and which prostaglandin pathway is implicated?

• A Kartagener syndrome; impaired ciliary motility
• B Churg-Strauss syndrome; ANCA-associated vasculitis
• C Samter's triad; shunting of arachidonic acid to the lipoxygenase pathway ✓
• D Young's syndrome; obstructive azoospermia with sinusitis

Explanation

Samter's triad (aspirin-exacerbated respiratory disease) consists of nasal polyps, chronic rhinosinusitis, and aspirin/NSAID hypersensitivity. COX-1 inhibition by aspirin blocks the cyclooxygenase pathway of arachidonic acid metabolism, shunting substrate toward the lipoxygenase pathway, thereby overproducing leukotrienes (LTC4, LTD4) that cause bronchoconstriction and eosinophilic mucosal inflammation. Treatment includes leukotriene receptor antagonists and aspirin desensitisation.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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