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Pulmonary puzzle
A young man with chronic cough: big is not always beautiful
  1. Sryma Punjadath,
  2. Karan Madan,
  3. Anant Mohan,
  4. Saurabh Mittal
  1. Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Dr Saurabh Mittal, Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi 110029, India; saurabh_kgmu{at}yahoo.co.in

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A 21- year-old Indian man presented with a history of shortness of breath and cough with expectoration for 2 years. The expectoration was copious in amount and was associated with occasional streaky haemoptysis. For 2 years, he had recurrent wheezing with good symptomatic improvement with bronchodilators. Spirometry performed 2 years previously demonstrated moderate obstructive ventilatory defect without bronchodilator reversibility. He had received multiple courses of oral steroids in the past year for treatment of exacerbations. He required hospitalisation thrice in the past year for infective exacerbations, requiring broad-spectrum antibiotics. His perinatal history was unremarkable and he had a history of pneumonia at 3 months of age. There was no history of recurrent infections in early childhood.

The presenting episode commenced with a 2 weeks history of right-side chest pain, fever and increased shortness …

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