Chronic Wet Cough as a Warning Sign of Bilateral Cystic Bronchiectasis in an Adolescent: A Case Report

Abstract

Background: Bronchiectasis is a chronic respiratory disease characterized by irreversible bronchial dilatation resulting from structural damage to the bronchial walls. In children and adolescents, chronic wet cough is an important clinical warning sign that may indicate chronic suppurative lung disease and should prompt further evaluation, particularly when accompanied by recurrent respiratory infections or other signs of chronic pulmonary disease. Case Presentation: A 17-year-old girl presented with hemoptysis and intermittent dyspnea. She reported a chronic productive cough with yellowish sputum and blood, recurrent respiratory symptoms since childhood, difficulty gaining weight, and a smaller body size compared with her peers. She had repeatedly sought treatment at primary healthcare facilities for persistent cough without significant improvement. Physical examination revealed mild respiratory distress, mild intercostal retractions, fine basal crackles, and digital clubbing. Her body weight was 31 kg, height 141 cm, and body mass index 15.48 kg/m², indicating undernutrition. Laboratory investigations showed leukocytosis (16.62 × 10³/µL), thrombocytosis (549 × 10³/µL), neutrophilia, an elevated neutrophil-to-lymphocyte ratio (5.8), and increased C-reactive protein (11.1 mg/L). Chest radiography demonstrated bilateral lower-lobe infected bronchiectasis with a possible underlying pulmonary tuberculosis and bilateral pleural effusion. Contrast-enhanced chest computed tomography revealed bilateral cystic and infected bronchiectasis. Sputum molecular testing did not detect Mycobacterium tuberculosis. The working diagnosis was bronchiectasis with clinically suspected pulmonary tuberculosis. The patient received azithromycin, antituberculosis therapy, and prednisone, with clinical improvement during hospitalization. Conclusion: This case highlights the importance of recognizing chronic wet cough as an early warning sign of bronchiectasis in children and adolescents, particularly when accompanied by recurrent respiratory symptoms, hemoptysis, impaired growth, and digital clubbing. Chest computed tomography can confirm structural bronchial abnormalities and define disease distribution. When radiological findings suggest tuberculosis but microbiological testing is negative, the relationship between tuberculosis and bronchiectasis should be interpreted cautiously. Early recognition, appropriate radiological evaluation, and systematic assessment of underlying etiologies are essential to prevent further progression of structural lung damage