CASE REPORT O ¨ mer Nuri Pamuk Æ Orbay Harmandar Æ Birsen Tosun Yener Yo¨ru¨ k Æ Necati C¸ akır A patient with ankylosing spondylitis who presented with chronic necrotising aspergillosis Report on one case and review of the literature Received: 2 March 2004 / Accepted: 18 October 2004 / Published online: 23 December 2004 Ó Clinical Rheumatology 2004 Abstract Upper lobe fibrobullous disease is a well- known finding in advanced stages of ankylosing spon- dylitis (AS). In this report, we present a 57-year-old male patient who was diagnosed with a right apical cavitary lesion after coming to us with the complaint of haemoptysis. The patient underwent upper lobe seg- mentectomy and an aspergilloma was detected. Histo- logic findings were in favour of necrotising Aspergillus pneumonia. It was interesting that the patient had not been diagnosed with AS before and presented initially with chronic necrotising Aspergillus pneumonia. In the literature, there are recently published series of pul- monary high-resolution computed tomography (HRCT) in AS which claim that parenchymal abnor- malities are quite frequent. Although the clinical sig- nificance of these abnormalities is not known with certainty, it has been reported that they might be seen even in early-stage patients. It is suggested that the pulmonary involvement in AS might be affected by mechanical factors related to limitation of motion of the thoracic cage and also by parenchymal inflamma- tion. Here, we review the series of pulmonary HRCT in AS patients. Keywords Ankylosing spondylitis (AS) Æ Aspergillosis Æ Fibrocavitary disease Æ High-resolution computed tomography (HRCT) Introduction The most commonly observed lesion during the course of ankylosing spondylitis (AS) is upper lobe fibrobullous disease and it is generally seen in advanced stages [1]. Although it is usually asymptomatic, it might radiolog- ically resemble tuberculosis and excavated neoplasm [1, 2]. In addition, apical fibrobullous areas might form the background for Aspergillus localisation [3, 4]. Until recently, it was thought that pleuroparenchy- mal involvement in AS was a rare extraskeletal finding [5]. However, with the more frequent use of high-reso- lution computed tomography (HRCT) for the evalua- tion of lung parenchyma, this idea has to be reconsidered. Series reporting on HRCT findings in AS in recent years suggest that pulmonary parenchymal abnormalities are more frequent than anticipated [6–12]. However, the clinical significance of these abnormalities is unclear. In this report, we present one patient who had inflammatory back pain for a long time, who presented with pulmonary symptoms and who was later diagnosed with chronic necrotising Aspergillus pneumonia and AS. In addition, we review series of AS patients who had pulmonary involvement based on HRCT findings. O ¨ . N. Pamuk (&) Æ N.C¸akır Department of Rheumatology, Trakya Medical Faculty, University of Trakya, Edirne, Turkey E-mail: onpamuk80@hotmail.com E-mail: necaticakir@hotmail.com Tel.: +90-284-2350001 O. Harmandar Department of Internal Medicine, Trakya Medical Faculty, University of Trakya, Edirne, Turkey B. Tosun Department of Pathology, Trakya Medical Faculty, University of Trakya, Edirne, Turkey Y. Yo¨ru¨k Department of Chest Surgery, Trakya Medical Faculty, University of Trakya, Edirne, Turkey N.C¸akır Altunizade, Okul Sokak, Erzurum Sitesi, No: 19/5 U ¨ sku¨dar, Istanbul, Turkey Clin Rheumatol (2005) 24: 415–419 DOI 10.1007/s10067-004-1047-8