Respiratory Medicine CME (2008) 1, 284e285

CASE REPORT

Bronchiectasis and chronic rhinosinusitis

Paul King a,b,*

a Department of Respiratory and Sleep Medicine, Monash Medical Centre, Clayton, Melbourne, Australiab Department of Medicine, Monash Medical Centre, Clayton, Melbourne, Australia

Received 7 March 2008; accepted 1 May 2008

KEY WORDSBronchiectasis;Rhinosinusitis;Trauma

* Department of Medicine, MonashRoad, Clayton, Melbourne 3168, Austfax: þ61 3 9594 6495.

E-mail address: paul.king@med.m

1755-0017/$34 ª 2008 Elsevier Ltd. Adoi:10.1016/j.rmedc.2008.05.003

Summary

A patient with post-traumatic rhinosinusitis for 10 years developed recurrent chest infections.Computed tomographic scanning demonstrated diffuse bronchiectasis. The bronchiectasis ap-peared to have developed as a complication of persistent upper airway sepsis.ª 2008 Elsevier Ltd. All rights reserved.

Introduction

A prominent feature of bronchiectasis is upper respiratoryinvolvement primarily rhinosinusitis. The mechanism forthis association is generally not well understood. Thisreport describes bronchiectasis occurring as a probablecomplication of persistent upper respiratory tract sepsis.

Case report

A 36 year-old man presented for assessment of recurrentchest infections. He had been very healthy as a child withno respiratory illnesses or relevant family history. At theage of 19 he was involved in a major motor car accidentwhere he sustained facial fractures. Over the next 5 yearshe had a series of operations on his nose principally tocorrect cosmetic deformities including SeptoeRhinoplasty

Medical Centre, 246 Claytonralia. Tel.: þ61 3 9594 6666;

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and bone grafting. In this period he developed symptoms ofrhinosinusitis with persistent nasal discharge and post-nasaldrip. He also described exacerbations occurring every 2e3months with purulent nasal discharge, pain over frontalsinuses, fever and constitutional upset. These symptomspersisted with no response to further surgery and partialrelief with antibiotics.

Ten years after the onset of his upper respiratory tractsymptoms he described developing a significant chestinfection with fevers and pleuritic chest pain. This episoderesponded well to oral antibiotics. Over the next 7 years hehad another four lower respiratory tract infections withchest X-rays demonstrating patchy lower lobe consolidationon two occasions. He worked as motor mechanic with noobvious effect on his symptoms and was light smoker(approximately five cigarettes a day for 10 years).

His current major complaints were his ongoing severepost-nasal drip and upper airway symptoms and dissatis-faction with his previous nasal surgery. On examination hewas a well-looking man who had tenderness over hismaxillary sinuses and scattered bi-basal crackles. Screeningof his immune function including full blood examination,immunoglobulin levels, cystic fibrosis (CF) mutations, allergic

Bronchiectasis and chronic rhinosinusitis 285

bronchopulmonary aspergillosis (skin test reaction, IgE andprecipitins) alpha-1 antitrypsin levels, lymphocyte andneutrophil function was normal. Spirometry demonstrateda borderline low FEV1 of 74% of predicted with the FEV1/FVC ratio of 0.73 and no significant bronchodilator effect.Lung diffusing capacity was in the normal range. A sinus CTscan showed bilateral inflammatory changes with occlusionof the ostiomeatal complex and mucosal thickening ofmucosal and ethmoid sinuses. A high resolution CT scan ofhis lungs demonstrated discrete areas of bronchiectasisinvolving segments of his right middle lobe, right lower lobeand left lower lobe. These areas of bronchiectasis hadassociated fibrosis.

Discussion

Non-CF bronchiectasis is associated with upper respiratorytract disease with studies reporting an incidence of 30e70%of rhinosinusitis in this condition.1e5 Why many patients withbronchiectasis have upper and lower respiratory disease incombination is generally not known. Primary ciliary dyski-nesia impairs function throughout the respiratory tract and isa classic but uncommon cause of bronchiectasis.6 It ispossible that this combination may reflect a susceptibility ofthe entire respiratory tract to infection. An alternativeexplanation in some patients is that infection may havestarted in one area of the respiratory tract and then spread.The incidence of upper respiratory tract symptoms inchronic obstructive pulmonary disease patients with chronicbronchitis is generally very low though.

In this case the patient appeared to have normalimmune function with no history of respiratory tractdisease until he developed post-traumatic rhinosinusitis.There was no evidence of another underlying cause for hisbronchiectasis. Nor did he have any evidence of anotherrespiratory condition or was there any history of respiratory

illnesses in childhood. He had worked as a motor mechanicfor the past 15 years with no association with his cough.There was no history of overseas travel or relevant familyhistory. Following a 10-year history of significant recurrentupper respiratory tract sepsis he then developed lowerrespiratory tract infections with bronchiectasis. Thesuggestion from this case is that bronchiectasis may occuras a complication of rhinosinusitis and this association hasnot been clearly described previously.

Conflict of interest statement

The author has no conflict of interest in this work.

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