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In the case of Legionnaires' disease described, severe respiratory problems necessitated mechanical ventilatory support, tracheal intubation, and positive end-expiratory pressure. Fever was eliminated with erythromycin therapy but returned after five days, and lung infiltrates spread. After supplementary treatment with other antibiotics and methylprednisolone sodium succinate, both the fever and the infiltrates disappeared. We feel that the multisystem involvement and the recrudescence of fever in our patient emphasize the wide spectrum of characteristics of Legionnaires' disease and the importance of continuation of antibiotics for a prolonged period to eradicate infection.

Synchronous dual primary lung carcinomas were found in 8 of 482 patients with lung cancer, an incidence of 1.6 percent. Of the 8 cases, 7 were unilateral and one bilateral. Three showed dissimilar histologic patterns occurring in combinations of squamous-cell carcinoma and adenocarcinoma. In 5 cases, two separate tumors were noted with identical histologic patterns in combinations of squamous-cell, giant-cell, large-cell, adeno-. and undifferentiated carcinoma. The patients were heavy smokers and this possibly may have been a factor in the development of carcinoma at more than one site.

Pulmonary fibrosis noted in ankylosing spondylitis rarely may become the seat of atypical epithelial proliferation leading to cancer.