A 49-year-old male had history of recurrent laryngeal papillomatosis spreading to the bronchus and lung parenchyma since childhood. He had been treated with repeated endoscopic CO₂ laser excision (figure 1). He had no smoking history. He was admitted with a 3-day history of worsening fever, cough and dyspnoea. Chest radiography showed a right lower lung mass, bronchiectasis, many cystic lesions and right pleural effusion (figure 2A). The right lower lobe mass measured 8.8×7.0 cm and had central hypodense areas consistent with necrosis (figure 2B, taken 8 years after figure 1) and there …