More Than Asthma: A Case Report of Eosinophilic Bronchiolitis

Eosinophilic bronchiolitis (EB) is a rare disease that may mimic or coexist with asthma, but EB typically fails to improve with guideline-based asthma treatments. A 52-year-old man presented with wheezing and shortness of breath for 5 months. He was found to have elevated peripheral blood eosinophils and moderately severe airflow obstruction but did not improve with high-dose inhaled corticosteroids in combination with long-acting beta2-agonist and long-acting muscarinic antagonist. Computed tomography revealed diffuse and widespread “tree-in-bud” changes. Transbronchial lung biopsy demonstrated eosinophilic bronchiolitis. The patient improved with a prolonged course of systemic corticosteroids. EB is distinguished from eosinophilic asthma by the presence of florid bronchiolitis on radiologic imaging or histopathology. The mainstay of treatment is systemic corticosteroids, with a possible role for biologics.