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Eosinophilic angiocentric fibrosis (EAF) is a rare inflammatory disease that primarily involves the nose and sinuses. Involvement of the eye orbit and larynx has also been described. However, it is very rare for this disease to involve the lower respiratory tract and cause dyspnea. We describe a rare case of EAF involving the lower respiratory tract with airway narrowing. A 29-year-old female with a 7-year history of nasal obstruction presented with unexplained persistent dyspnea. EAF was diagnosed via endoscopic biopsy of an irregular mucosal lesion in the posterior wall of the right maxillary sinus. Chest computed tomography and bronchoscopy showed a diffuse inflammatory narrowing of the airway in the tracheobronchial trees. EAF can affect lower respiratory tracts with airway narrowing that can be characterized by dyspnea. We must consider narrowing of the lower respiratory tracts in patients with EAF complaining of unexplained persistent dyspnea.

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Afatinib 2.) Use Anti-PI3K or mTOR-inhibitor such as Torisel 20 mg IV weekly.Results: 21 cases of T790M activating mutation came from: 1.) 22 cases of classical exon 19 deletion had 5 cases of T790M 2.) 7 cases of exon 21 point mutation had 6 cases of T790M 3.) 13 cases of various exon 19 mutation had 10 cases of T790M All 21 cases of T790M survived the resistance treatment at least 1 year after the discovery T790M. Conclusion: Our results appeared to show; 1.) Multiple targeted medicines treatment appeared to reduce the resistance to TKI 2.) Those harbored classical exon 19 deletion appeared to have less TKI resistance 3.) Those harbored exon 21 EGFR mutation and non-classical exon 19 mutation appeared to have TKI resistance more (average 1 year) 4).We could avoid using chemotherapy in those who developed TKI resistance at least in a short period of time and it will require further study.