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A 17 year old non-smoker male student, a known asthmatic since birth, presented with high grade fever, purulent non-foul smelling expectoration and breathlessness. Patient gave history of expectorating brownish plugs off and on in past. His father and maternal grand father were asthmatic. Chest auscultation revealed bilateral rhonchi and bronchial breathing with few crepitations in left infraclavicular region. His chest skiagram was as in Fig. 1. Total white blood counts were 13400 mm with 78% neutrophils, 12% lymphocytes and 10% eosinophils and erythrocyte sedimentation rate (ESR) was 44 mm 1st hr (Westergren). Sputum smears for acid fast bacilli were repeatedly negative.
