The patient was a 29-year-old male from Tehran, with a history of multiple hospitalizations for lung infection who presented to the pulmonary clinic with a complaint of chronic productive cough which had worsened in the previous year. He had been hospitalized two to three times for his respiratory condition and once in childhood when he was 10 or 11 years old. The hospitalizations helped him a little, but his sputum production had gradually increased. Since his last hospitalization, which had been 2 years earlier, he had had persistent sputum production with expectoration two or three times an hour. The patient also complained of shortness of breath and wheezing. He denied fever, chills, hemoptysis, or exposure to tuberculosis. He had had measles in childhood. He denied any other past medical history or surgery. He was up to date on his vaccinations, was not on any medications, and denied any drug allergies. He was a nonsmoker and did not use drugs or drink alcohol. He was married and worked in an office. He reported having kept a canary at home for the previous year. He denied any medical illnesses in his family, including lung disease.
On physical examination, he was in no acute distress, with a blood pressure of 110/70 mmHg, a pulse rate of 72 beats per minute, a respiratory rate of 20 per minute, and an oral temperature of 37 C. He was alert and orientated. He had no lymphadenopathy or sinus tenderness. Heart sounds S1 and S2 were heard, with no murmurs, rubs, or gallops. On pulmonary examination, breath sounds were hyperresonant on the left side. The abdomen was soft and nontender with no organomegaly. Neurology examination was normal. There was mild clubbing of his nails, but no cyanosis or edema.
Chest x-ray showed extensive pulmonary cysts on the left side, with mediastinal shift to the left. Computed tomography scan of the thorax without contrast showed a normal heart, mediastinum, and pleura, with shift to the left side and hyperaeration of the right lung. There were multiple medium-sized, thick-walled cystic lesions, some containing fluid, in the left lung (mostly in the upper lobe), with volume loss in favor of bronchiectasis. The right lung had normal parenchyma and bronchovascular markings. Laboratory investigations showed a white cell count of 10 x 103 cells/muL and an erythrocyte sedimentation rate of 17 mm/hour.
In view of illness since childhood, investigations were undertaken to exclude congenital causes of bronchiectasis. The patient was referred for a sweat chloride test and measurement of immunoglobulin levels. Body plethysmography was ordered with culture of sputum for bacteria, fungi, and mycobacteria. Three consecutive sputum smears for acid-fast bacilli were negative. The etiology of bronchiectasis was most likely measles in childhood. The patient's symptoms responded to ciprofloxacin and an albuterol metered dose inhaler.