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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 …