Seven patients are reported who had ankylosing spondylitis and chronic fibrotic lung disease. From a study of these and previously published cases it is evident that the disease usually appears several years after the onset of joint symptoms. It begins as apical consolidation and fibrosis and usually extends to the upper zones and sometimes the mid zones. When it is not bilateral from the start it often becomes so. Cavities develop in most cases and they often become colonized by aspergilli with the formation of fungus balls.Histologically there is interstitial fibrosis in the early stages. Later there is dense fibrosis and bronchial dilatation which usually progresses, with the formation of bullae and cavities.Though the appearances are similar to chronic tuberculosis there is no evidence that it is caused by tuberculosis, other bacterial infections, or by radiotherapy. It appears justifiable to regard it as another extra-articular manifestation of ankylosing spondylitis.The condition is contrasted with the lung disorders that complicate rheumatoid arthritis.The evidence for an increased frequency of pulmonary tuberculosis in patients with ankylosing spondylitis is re-examined. The apparent increase is due, in part at least, to the mistaken inclusion as tuberculosis of the condition described. There is also some evidence that when patients with ankylosing spondylitis do develop tuberculosis, and the infection is eradicated with chemotherapy, they may then develop progressive non-tuberculous destructive lung changes.
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