A 48-Year-Old Woman With a History of Severe Asthma and Bilateral Minute Pulmonary Nodules.

A 48-year-old woman was referred to a thoracic surgeon for lung biopsies because of the presence of widespread bilateral minute pulmonary nodules. She had been followed up and treated for nonallergic asthma since 27 years of age and sleep apnea syndrome. She was treated with high-dose inhaled corticosteroids combined with long-acting β-agonists and anticholinergic bronchodilators. For 4 years, she experienced > 3 asthma exacerbations related to air pollution and respiratory infections that required oral corticosteroid therapy. She had never smoked and kept domestic birds and rabbits for several years. She described an increase in respiratory symptoms when handling hay. Given the severity of the symptoms, her outpatient pulmonologist proposed introducing a new treatment with biologic therapy for the severe asthma. However, before initiation of therapy, a CT scan was performed for further evaluation.