PMC6728995_01
PMC6728995_02
Paranasal computed tomography images before treatment. Pretreatment computed tomography at 8 years and 6 months of age shows paranasal sinusitis. The scans reveal secretory reservoirs in the frontal, maxillary, ethmoid, and butterfly paranasal sinuses
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Fig1
Eosinophilia, bilateral nasal polyps, and pansinusitis were observed via computed tomography (Fig. 1), and the diagnosis was severe refractory BA associated with ECRS.
Endoscopic images of the bilateral nasal cavity and histological analysis of the nasal polyps. a The endoscopic images show polyps in the bilateral nasal cavity. b Histological analysis shows numerous eosinophils in the polyps. Hematoxylin and eosin staining x200. All paranasal sinuses were released, but after 4 months later, the nasal polyps recurred
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Fig2
After surgery, the BA was controlled during PSL dose reduction, but 4 months after surgery, the nasal polyps recurred and an eosinophilic infiltrate was found in the extracted nasal polyps (Fig. 2).
PMC6728995_03
Growth curve of the patient height and weight. The effects of oral steroids suppressed the patient height growth and gained weight. His growth has been restored as the symptoms improved with the administration of omalizumab and he was able to lose weight on oral steroids. B.Ht. and B.Wt. indicate body height, and body weight, respectively
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Fig3
As we were concerned that long-term oral steroid administration might slow his growth, we started tapering PSL and CsA after 9 months (Fig. 3).
PMC6728995_04
Clinical course and laboratory findings. A timeline of the treatments, symptoms, IgE levels, eosinophil counts, and %FEV1.0 is presented. PSL prednisolone, ICS/LABA inhaled long-acting beta-agonist/corticosteroid, CsA cyclosporine, BIS budesonide inhalation suspension, FP fluticasone propionate, SLM salmeterol xinafoate, ESS endoscopic sinus surgery
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Fig4
A flow chart showing the treatments and responses is presented in Fig. 4.