A 32-year-old woman with bronchial asthma and bilateral nasal polyps reports that taking aspirin for fever consistently precipitates acute wheezing and rhinorrhoea. The most likely diagnosis is:

• A Allergic fungal rhinosinusitis
• B Aspirin-exacerbated respiratory disease (Samter triad) ✓
• C Eosinophilic granulomatosis with polyangiitis
• D Non-allergic rhinitis with eosinophilia syndrome

Explanation

The combination of asthma, nasal polyposis, and aspirin intolerance constitutes Samter triad, also called aspirin-exacerbated respiratory disease. Aspirin inhibits cyclooxygenase 1, shunting arachidonic acid metabolism toward the 5-lipoxygenase pathway with excess leukotriene production, which triggers bronchospasm and rhinorrhoea. EGPA can mimic this picture but requires systemic features such as vasculitis, neuropathy, or marked eosinophilia, none of which are described here.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.