18 yrs old female from baghdad , iraq presented to a tertiary hospital ER with SOB for 3 days , she has hx of recurrent respiratory infections and foul smelling green color large amount sputum not excreted unless the patient takes the leaning forward posture , so as a syndrome she has primary immobile cilia with dextrocardia and situs inversus totalis , it was very interesting case , she has two brothers with the same condition , one of her brothers has died recently at the age of 40 and he was infertile as well , she is getting better on O2 and antibiotics but recurrent infections already present , god be with her !