A 37-yr-old male complained of a dry cough, fever, nocturnal sudation and dyspnoea. On lung auscultation, his general practitioner noticed right-sided expiratory wheezing and the diagnosis of tracheitis was withheld. Clarithromycin and a cough syrup were given and a slight amelioration was noticed, except for the persistence of dry cough. Bronchial hyperreactivity was suspected and a combination of budesonide and formoterol was added to the treatment.During the following 2 months, symptomatology varied; cough and dyspnoea were intermittently present until the patient started complaining of right thoracic pain and important fatigue. Fever re-appeared reaching 39uC, and, after consulting his general practitioner, cefuroxime and paracetamol were prescribed.Once again the fever disappeared, but a very invalidating cough with mucopurulent sputum, fatigue and chest pain persisted. After the antibiotic was stopped, fever reappeared and the patient was hospitalised.In his past history the patient was treated at the age of 12 yrs by immunotherapy for an allergic rhinitis caused by dust allergy. There was no particular familial history. He had never smoked and worked in an office.On clinical examination, the patient was pale, sweaty and thin. His blood pressure was 125/65, pulse 100?min -1 and temperature 38.7uC. On lung auscultation, breath sounds were diminished at the right lung base. Otherwise, physical examination was normal.Laboratory studies demonstrated a white blood cell count of 16610 9 ?L . Liver tests, renal and serum chemistry were normal.A chest radiography and a CT scan of the lungs and mediastinum were performed (figs 1 and 2).Flexible bronchoscopy showed a polypoid, necrotic, highly vascularised tumour occluding the right bronchus intermedius. No biopsies were taken, but instead a diagnostic and therapeutic rigid bronchoscopy was performed.