Severe Eosinophilic Asthma (TH2) – Case report.

Abstract

Introduction: Th2 lymphocytes recruit eosinophils, promoting the local and systemic synthesis of IgE. Eosinophilic asthma is characterized by increased eosinophil concentrations and type 2 allergic inflammation in the airways, leading to frequent exacerbations and worsening lung function, making it a severe and difficult-to-treat subtype of asthma. This phenotype corresponds to 10% of the asthmatic population.

Clinical case: A 20-year-old man with a history of asthma and atopic dermatitis was admitted to the emergency department with dyspnea, cough, expectoration, a sensation of chest tightness, nasal flaring, intercostal retraction, thoracoabdominal dissociation, peripheral saturation of 90%, tachycardia 130 bpm, blood pressure 150/90 mmHg and temperature rise of 38°C. On physical examination, edema of the epiglottis and buccal cords was observed; on auscultation, there was expiratory wheezing in both disseminated lung fields.

Diagnostic workshop: Eosinophils 9% (790 u/µL). ANCA negative, IgE 10789 UI/ml. Culture of sputum Aspergillus Spp. Negative. Chest CT: opacity with left supradiaphragmatic air bronchogram and pleural thickening, with bilateral entrapment and bronchiolitis.

Evolution: He received ampicillin + sulbactam, IV hydrocortisone, inhaled budesonide 400 µg every 8 hours, salbutamol, and ipratropium 160/4.5 µg every 8 hours. Difficult-to-control asthmatic patient (th2) with good clinical response, absence of rhonchi and wheezing, and eosinophils within normal ranges. Medical discharge was given prednisone 20 mg every day, and the dose was reduced on the 5th day.

Conclusions: Eosinophilic asthma represents a heterogeneous group of patients who constitute a diagnostic challenge. A practical classifier for this phenotype has yet to be available, but rather the characteristic of rapid response to intravenous and oral steroids.