A 38 year old patient presents with productive cough with blood tinged sputum. He gives a history of recurrent rhinitis and wheezing. A general practitioner had treated him for asthma and currently referred him due to expectoration of blood tinged sputum and weigh loss. The patient does not give any history of fever. Examination reveals nasal polyposis, cervical adenopathy and bilateral rhonchi. Investigations show a peripheral eosinophil count of 24%.
Sputum is negative for acid fast bacilli on three consecutive days. Chest X-ray shows ground glass opacities of both lung field and multiple pulmonary nodules. CT chest confirms these findings along with consolidation. Transthoracic biopsy of a predominant left lower lobe nodule identified on CT is performed. Culture, gram stain and acid fast staining of the biopsy do not reveal any bacterial, mycobacterial or fungal pathogen.…
