A 38-year-old asthmatic patient presents with nasal obstruction, anosmia, and bilateral nasal polyps. CT paranasal sinuses shows opacification of all sinuses with bilateral polyps. Tissue eosinophilia is >50 cells/HPF on biopsy. Which phenotype of chronic rhinosinusitis with nasal polyps (CRSwNP) best characterises this patient?
- A Aspirin-exacerbated respiratory disease (AERD) phenotype — Type 2 endotype ✓
- B Non-eosinophilic CRSwNP — neutrophilic endotype
- C Allergic fungal rhinosinusitis (AFRS) endotype
- D Central compartment atopic disease (CCAD)
Explanation
This patient's triad of asthma, bilateral nasal polyps, and anosmia with high tissue eosinophilia (>50/HPF) is the classic eosinophilic CRSwNP phenotype; when combined with NSAID sensitivity it defines AERD (Samter's triad). The Type 2 inflammatory endotype (IL-4, IL-5, IL-13, IgE-driven) drives eosinophilic polyps and concurrent asthma. AFRS would show allergic mucin with Charcot-Leyden crystals and peripheral eosinophilia along with characteristic CT findings; CCAD spares the ethmoids with predominant middle turbinate/septal polyps; non-eosinophilic CRS has neutrophilic or mixed inflammation.
Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.