BGDD

35

female

The patient presented with the history of productive cough, hemoptysis, wheezing, dyspnea, headache and occasional fever. At clinical examination, the patient is ill looking, anxious, emaciated. There is generalized clubbing present in both toes and fingers. Crepitations and rhonchi were evidenced in both lung field. A chest X-ray showed dextrocardia, Chest CT revealed dextrocardia, bronchiectasis, left liver, and spleen on the right. Echocardiography confirmed dextrocardia, too. A PNS radiograph shows bilateral maxillary sinusitis.

The patient is treated with a combination of inhaled bronchodilatators (inhaled corticosteroids + long-acting beta-2 agonists), and occasional administration of antibiotics, oral prednisolone, mucolytics in episodes of exacerbations of disease over a period of 7–14 days.

25

male

Patient presented with fever, cough with productive sputum and breathlessness for seven days. Fever was intermittent, high grade associated with chills and rigors, highest recorded temperature as 101 degrees Fahrenheit. Sputum was yellowish, copious in volume, foul-smelling but not associated with haemoptysis. He also complained of rhinitis and intermittent headaches. On query, he admitted to recurrent episodes of common cold, sneezing and nasal blockade, and productive cough with exertional breathlessness for the past 8 years. He was a non-smoker, and born to non-consanguineous parents. He had stable haemodynamic parameters and digital clubbing. Lung auscultation revealed vesicular breath sounds with prolonged expiration, and bi phasic coarse crackles and wheeze over both lung fields. Precordial examination revealed dextrocardia, with apex beat in the left fifth intercostal space; heart sounds were both audible in the right side of the chest with no murmurs. Electrocardiogram showed evidence of dextrocardia with right axis deviation, positive QRS complexes with upright P and T waves in lead aVR, inverted P and T wave inversion in lead I, and absent R wave progression of the chest leads (Fig - 2). HRCT of chest showed ring shadows of thickened walls of dilated bronchi more predominant over the basal lung fields indicate bilateral bronchiectasis (Fig -3) .Xray of the paranasal sinuses occipito-mental view revealed bilateral maxillary sinusitis (Fig - 4). Blood counts revealed mild leucocytosis. Sputum culture revealed no growth. Sputum for AFB not found . MT negative. Our patient was unmarried and denied any sexual activity so it was difficult to come to a conclusion regarding his fertility, but he counselled regarding the possibility of infertility and the need for semen analysis.

The patient was given chest physiotherapy, bronchodilators and intravenous antibiotics for 7 days. He was afebrile and showed clinical improvement. The patient was discharged on immunomodulatory therapy comprising of Azithromycin thrice weekly.