Recurrent Respiratory Infections

🗒️ Question 

A 34 year old woman presents with a persistent cough, shortness of breath and recurrent respiratory infections. Despite multiple courses of antibiotics, her symptoms have not improved. She has no history of smoking and there is no family history of respiratory conditions.

Physical examination reveals clubbing of the fingers and bilateral coarse crackles on auscultation. Her chest X-ray shows diffuse interstitial infiltrates. High-resolution computed tomography (HRCT) reveals cystic changes predominantly in the lower lobes, along with tree-in-bud opacities.

What is the most likely diagnosis?

(A) Bronchiectasis
(B) Idiopathic pulmonary fibrosis
(C) Sarcoidosis
(D) Cystic fibrosis
(E) Allergic bronchopulmonary aspergillosis