Differential Diagnosis

  • Asthmatic granulomatosis (Wenzel)

    • Meet asthma diganostic criteria (bronchodilator reversibility or positive methacholine challenge), with modest obstruction and some evidence of decreased FVC and DLCO, and elevated blood eosinophils or exhaled NO despite prednisone
    • Often adult-onset or adult worsening
    • Associated with autoimmune family history (70%)
    • Can only be diagnosed by biopsy via VATS
      • Sinus CT often demonstrates sinusitis and chest CT is often normal
    • Treatment is with alternative antiinflammatory medications (MTX, mycophenolate, azathioprine) which may improved FEV1 and decrease exacerbations