A Rare Case of Bilateral Aspergillomas in a Patient of Ankylosing Spondylitis.

Pulmonary involvement by Aspergillus sp. mainly includes allergic bronchopulmonary aspergillosis, aspergilloma, and invasive aspergillosis. Aspergilloma (Fungal ball) is the most common form of aspergillous pulmonary involvement, which occurs in preexisting pulmonary cavities, especially secondary to pulmonary tuberculosis. Ankylosing spondylitis is a rare cause of upper lobe fibro-cavitary lesions in pulmonary parenchyma. It may also lead to development of fungal balls in pulmonary cavities. Most common presentation is mild to massive hemoptysis; dyspnoea, chronic cough, expectoration may be other presentation; even the patient may remain asymptomatic. Intaracavitary mobile mass is a valuable sign for fungal ball, best detected by computed tomography (CT) scan of thorax. Lobectomy is the treatment of choice to stop the hemoptysis, if the general condition of the patient is fit; otherwise associated co-morbidities complicate the post-operative scenario. In this situation, bronchial artery embolization may be used as a temporary measure to control hemoptysis. Here, we report a case of bilateral aspergillomas within the cavities located in upper lobes of both lungs in a 74 years old male who was suffering from ankylosing spondylitis for last 42 years.

A case of paraneoplastic bullous pemphigoid in association with squamous cell carcinoma of lung.

Bullous pemphigoid is a chronic, autoimmune, acquired subepidermal blistering disorder. It is idiopathic in origin, and mainly seen in elderly individuals. Association between bullous pemphigoid and internal malignancies is reported in the literature, but the exact causal relation is not established. Paraneoplastic bullous pemphigoid is rarely reported in lung cancers, especially in squamous cell variety. So their presence should raise the suspicion of various internal malignancies including lung cancer. It is presented mainly with tense, large blisters over the erythematous base or over normal skin. Subepidermal blisters with tissue eosinophilia are characteristic histopathological features of bullous pemphigoid. Direct immunofluorescence shows linear deposits of IgG - complement complex along the dermoepidermal junction. Conventional treatment of bullous pemphigoid along with treatment of lung cancer (surgery, chemotherapy, radiotherapy) may result in successful resolution of skin lesions. Here, we report a rare association of paraneoplastic bullous phemphigoid and squamous cell carcinoma of lung in a 76-year-old male to increase the awareness among the clinicians regarding this variety of cutaneous paraneoplastic manifestation of lung cancer.

Gestational choriocarcinoma presenting as hemothorax.

Choriocarcinoma include a spectrum of chorionic neoplasms that may be gestational or non-gestational. By virtue of their high vascularity and affinity of trophoblast for blood vessels, metastases often occur early, and the most common site of such metastases is the lung. Metastatic pleural effusions from choriocarcinoma are infrequent. Pleural seeding usually results from extension of a sub-pleural peripheral nodule. We describe a case of gestational choriocarcinoma whose clinical presentation was medical like hemothorax as in our case rather than gynecologic.