A patient with ankylosing spondylitis and recurrent haemoptysis.

A 54-yr-old male presented with a history of recurrent episodes of haemoptysis over the previous 2 yrs. The patient also complained of back pain and stiffness for 15 yrs due to ankylosing spondylitis. Over the previous 2 weeks, he had been complaining of progressively increasing dyspnoea, malaise and fever. The fever persisted despite antibiotics and the patient showed acute severe haemoptysis. He drank little alcohol and had ceased smoking a few cigarettes daily 20 yrs previously. He had no previous history of pulmonary tuberculosis. On admission, he was pale and complained of nonproductive cough. His temperature was 37.6uC, pulse rate 98 beats?min, respiratory frequency 30 breaths?min and blood pressure 160/90 mmHg. On physical examination, the patient was a thin male, who appeared comfortable at rest, without respiratory stridor. No lymphadenopathy was evident. The head and neck were normal.