[Bacterial endotoxin as a trigger for eosinophilic asthma]

Introduction: Lipopolysaccharide is a component of the outer membrane of gram-negative bacteria. It plays an important role in asthma as an adjuvant to allergens in activating the airway epithelium.

Case report: Following treatment of a cutaneous mycosis by injection of endotoxin from Salmonella (Pyrogenalum), a 49-year-old non-smoking man developed an acute bronchitis followed by persistent cough, sometimes productive of sputum. Clinical examination was unremarkable. Lung function tests showed airway obstruction, FEV1 54% predicted, partly reversible with salbutamol, and exhaled NO was increased to 73.5 ppb. There was a moderate blood eosinophilia ranging from 540 to 890 per mm(3) (7.4 to 9.6%). Lung CT scan showed no parenchymal or bronchial abnormalities, and ENT examination showed nasal polyposis.

Conclusion: Besides its critical adjuvant role in the development of asthma when inhaled, this case suggests that endotoxin can also provoke asthma when administered systemically.