Case reports: Pulmonary destructive lesions caused by ankylosing spondylitis

Background: Ankylosing spondylitis (AS) frequently produces thoracic-cage deformities-kyphosis and rib fusion-that restrict chest expansion and impair ventilation, occasionally progressing to atelectasis or pulmonary fibrosis. Such pulmonary manifestations are often misdiagnosed as tuberculosis or fungal disease. Case presentation: We describe two AS patients with bilateral upper-lobe destruction whose initial chest CT scans suggested tuberculosis. After thorough microbiological work-up remained negative, both were diagnosed with AS-associated lung injury (ASLI) and referred to rheumatology. Because destroyed lung carries lifelong risks of infection and hemorrhage, long-term respiratory follow-up was recommended. Conclusion: We describe two AS patients with bilateral upper-lobe destruction whose initial chest CT scans suggested tuberculosis. After thorough microbiological work-up remained negative, both were diagnosed with AS-associated lung injury (ASLI) and referred to rheumatology. Because destroyed lung carries lifelong risks of infection and hemorrhage, long-term respiratory follow-up was recommended.