High Index of Suspicion Has Life-Changing Results in an Older Adult Patient

A 70-year-old man with progressive bronchiectatic lung disease, cirrhosis, and hepatocellular carcinoma supposedly secondary to hepatitis B was referred to our institution for further evaluation. A detailed medical history identified the patient as of Romanian Jewish ethnicity with no prior familial or genetic disease reported. As a young child, he reported hospitalization for failure to thrive but no respiratory complaints. In adulthood, he underwent a cholecystectomy for gallbladder stones and successful fertility treatment resulting in 2 children. His liver and lung diseases became clinically significant in his late 40s. Chronic productive cough and repeated episodes of hemoptysis led to a diagnosis of bilateral bronchiectasis, particularly affecting the upper and middle lobes. A few years prior, he underwent angiography and embolization of a tortuous left bronchial artery due to massive hemoptysis. The patient reported anorexia and significant weight loss of 20 kg, accompanied by intermittent diarrhea, which were attributed to his underlying lung and liver conditions.