Giant condyloma acuminatum (GCA) or Buschke-Loewenstein tumor is a rare disease, with an estimated prevalence of 0.1%. It was initially described in 1896 by Buschke and later in 1925 by Buschke and Loewenstein. Classic condyloma acuminata (CCA) and squamous cell carcinoma (SCC) were initially described as different entities. These three entities are currently considered to correspond to the same spectrum of different but not exclusive malignant transformations, associated with multiple risk factors such infection by human papilloma virus (HPV), immunodeficiencies, poor hygiene, multiple sexual partners, and chronic genital infections. HPV subtypes 6 and 11 are associated with 90% of GCA. It presents as a cauliflower-like tumor in the genital region with bad odor, bleeding, and local infection, differential diagnosis with multiple conditions should be considered, and sexually transmitted diseases should always be investigated. GCA has a higher rate of malignant transformation than CCA and tends to infiltrate adjacent soft tissues. The therapeutic approach is controversial but is considered that the resection with free edges is the gold standard and can be combined with adjuncts. The recurrence rate is high. Overall mortality is 21% and is associated with morbidity caused by recurrences. Imiquimod cream 5% has recently shown good results as monotherapy and in combination with ablative and surgical treatments. The quality of life is diminished in patients with this condition. In this review, we address the different aspects of this rare entity including the therapeutic approach.

Thymoma is an entity with an estimated incidence of 1.2-3.2 per million people, with a prognosis and treatment determined by its clinical stage and histological classification, the most widely used classification systems being the Masaoka-Koga for clinical stage and that of the world health organization (WHO) for histology. Necrotizing pneumonia is another rare entity that was initially described in adults in the 1940s; however, it is currently being studied more extensively in the pediatric setting, and currently its treatment, especially in adults, is unclear and surgical treatment usually reserved in the presence of complications and poor response to medical management. The coexistence of two rare entities is a problem for which therapeutic options are limited; the general condition of the patient is a determining factor in the outcome in a critically ill patient. In the present case, the association of two infrequent entities is reported, which presented a pneumothorax as a complication that required placement of an endo-pleural tube for drainage, pre-surgical biopsy a B1 thymoma was reported. The post-surgery pathology report was an encapsulated thymoma, WHO type A, the broad-spectrum antibiotic management did not prevent the dissemination of the septic focus in the context of a patient with malnutrition and immunosuppression.