A case of Kartagener’s syndrome: Importance of early diagnosis and treatment
A twelve year-old boy came to our institute with complaints of recurrent sore throat and cough with yellowish expectoration intermittently for past three to four years with episodes of fever; weight loss of about two to three kg over past one year; chronic wheezing; and chronic use of antibiotics for past two to three years with occasional steroids.\nThe patient was a moderately built fair young boy, who was dyspneic, coughing, and short of breath. He was febrile, conscious, and oriented. No pallor and no icterus. Clubbing grade 2 was present. JVP was not raised and no edema feet. A few submental lymph nodes were palpable, which were mildly tender. Auscultation of the chest revealed diffuse bilateral ronchi with scattered crepitations over both infrascapular regions. Chest expansion was reduced. Surprisingly, we could not hear his heart sounds on the left side, but they were appreciable over right side and those were normal cardiac sounds. Apex beat was palpable over the fifth intercostal space on the right side of chest. Rest of the physical and systemic examination were normal.\nWe did an electrocardiogram (ECG) on him with both right and left-sided chest leads, which revealed inverted “P” waves in L1 and AVL []. The ECG was normal on right-sided chest leads [Figures and ].\nThe ultrasonography of abdomen revealed situs inversus, but rest of the scan was normal. His high resolution computed tomography (HRCT) chest revealed bronchiectatic changes [] and CT abdomen again confirmed situs inversus []. X-ray and CT para nasal sinus revealed pansinusitis.\n2D echo was consistent with dextrocardia; all four chambers were normal. Doppler study confirmed situs inversus of aorta and inferior vena cava.\nHis hemogram revealed a total leucocyte count of 14700/cu.mm. erythrocyte sedimentation rate was 35 mm after 1st hour. Liver and renal functions were normal as was the urine examination.\nAnti nuclear antibody, anti nutrophilic cytoplasmic antibody, and human immunodeficiency virus serolgy were negative. Serum angiotensin converting enzyme levels and Serum Immunoglobulin E (IgE) were normal. Tuberculosis (TB) gold Quantiferon was negative. Sputum for acid fast bacilli did not reveal the tuberculosis bacilii. Gram stain of the sputum revealed numerous gram positive cocci in pairs and gram negative bacilli. Sputum culture was sterile.\nHe was operated for sinusitis (functional endoscopic sinus surgery) at the same institute by our ENT team. Bilateral middle turbinates were fused with the uncinate process. Fused portion was opened using microdibrider and frank pus was found in both bulla ethmoidalis. Bulla was opened and pus was removed. Bilateral inferior meatal antrostomy was done. Subsequently, he was advised vaccination for influenza and pneumococcal vaccine, inhaled steroid and bronchodilator, a mucolytic, and antibiotic course with regular follow-up in ENT, Pulmonology, and Internal Medicine OPD. After 2 months of follow-up, the patient is doing well, although he continues to have intermittent cough of mild intensity.