Correct!
3. Biopsy of nasal or auricular cartilage
The constellation of signs / symptoms suggests a particular diagnosis which can be corroborated through biopsy of affected tissue. Tracheostomy placement is not necessary at this point, and given this patient’s condition [see below], would be ineffective anyway. Increasing the corticosteroid dose may have some positive effect, but it is unclear what exactly is being treated and therefore the endpoint for therapy is similarly uncertain, as no diagnosis has yet been established. Furthermore, increases in corticosteroid doses in this patient previously did not provide a durable benefit, and he is now experiencing complications from this therapy. Adding non-steroidal anti-inflammatory medication and referring to physical therapy will not establish the diagnosis and is premature at this point. Repeat thoracic CT is unlikely to reveal any information not already known from the initial thoracic CT.
The patient underwent flexible fiberoptic bronchoscopy with biopsy, which showed a thickened basement membrane and chronic inflammation interpreted as consistent with asthma. Otolaryngology performed nasal cartilage biopsy which showed chronic inflammation.
The combination of the patient’s symptoms and a biopsy showing chronic inflammation at one of the involved sites suggests what diagnosis?