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Two patients with tracheobronchopathia osteochondroplastica are described, both presenting with features suggestive of bronchial carcinoma. They had a long standing history of recurrent haemoptysis. The characteristic bronchoscopic, radiological and histological features of the condition are illustrated and the clinical problems in diagnosis discussed.

Anaphylactoid reactions to oral, topical, and parenteral corticosteroids have been reported.'-' This may present serious problems in management should steroid treatment be required. We describe a patient who showed an anaphylactoid reaction to several different corticosteroid preparations and was successfully desensitised to hydrocortisone.Case report A 31 year old woman with a history of urticaria and chest tightness precipitated by salicylate ingestion was admitted in 1972 with an acute attack of asthma (FEV, 1.05 1). On discharge she was having prophylactic treatment that included 7.5 mg prednisolone daily, (FEV, 1.65 1). Six months later she developed an urticarial eruption over the upper face; she had ingested no salicylates. Beclomethasone dipropionate by inhalation was introduced and the oral prednisolone reduced to 2.5 mg daily; the rash subsided. The patient remained well with 2.5 mg prednisolone daily for six years (FEV, 1.50-1.90 1), but after worsening of her asthma (FEV, 0.75 1) the dose of oral prednisolone was increased to 7.5 mg daily and there was a recurrence of urticaria over the face and trunk associated with truncal and limb purpura. Investigations including platelet count, Hess test, clotting factor assays, and tests for platelet adhesion and aggregation with collagen and ADP showed no abnormality. The prednisolone was withdrawn and tetracosactrin depot 1 mg intramuscularly twice weekly was introduced. Initially basal plasma cortisol concentrations were low (<50 nmol/l) and rose little in response to tetracosactrin. About six weeks after the introduction of tetracosactrin depot, although the morning cortisol concentration remained low, the response had improved-a cortisol concentration of 1175 nmol/I being achieved. Initially the urticaria and purpura subsided, but after three months it was noted that the rash recurred within 24 hours of administration of tetracosactrin, subsiding again over the following 48 hours. During two weeks while on holiday the patient received no tetracosactrin and remained well and free of rash during this period. Twenty four hours after receiving a further injection of tetracosactrin she developed right iliac fossa pain and an extensive pruritic papular eruption over the face, limbs, and buttocks. Tetracosactrin

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Macroscopically, the proximal airways were widely dilated and contained sausage-like masses of inspissated material. Smaller airways were dilated and surrounded by scar tissue; distally bronchopneumonia appeared to be present. Microscopically the plugs of material within bronchi consisted of aggregates of cellular debris, eosinophilic material, and large numbers of Charcot-Leyden crystals. Viable eosinophils were adjacent to the cellular debris. Stains for fungi showed scanty septate hyphae compatible with an Aspergillus species. The large airways were partly lined with hyperplastic epithelium and by granulation tissue. The more distal airways were lined by scar tissue, the inner aspect of which showed a fibrillary fibrinoid necrosis. Eosinophils were frequent in the walls of proximal airways and in collapsed fibrosed parenchyma around the distal airways. Occasional multinucleate giant cells and histiocytes were seen in relation to the eosinophilic necrosis of Address for reprint requests: Dr MD Clee,