4th March 2024

A 21-year-old man presents to the acute medical unit with a cough and purulent sputum

A 21-year-old man presents to the acute medical unit with a cough and purulent sputum. He notes that he has had recurrent chest infections since adolescence. He would also occasionally get purulent discharge from his nasal passages. He denies any diarrhoea or foul-smelling stools.

Examination today reveals coarse breath sounds throughout his lung fields with scattered wheezing along the upper zones. A CXR showed increased bronchial markings with tram-track opacities. His heart shadow appears to be on the right side of his chest. Blood tests show neutrophilia with normal eosinophils.

What is the likely underlying diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.