A 35-year-old man presented to the accident and emergency department with history of productive cough, breathlessness and some weight loss over several weeks. He had a past medical history of asthma and eczema. He mentioned that, at times, he had been expectorating sputum with some haemoptysis over the past few months. He was of Bangladeshi origin, but had been resident in the UK since 1986 and last visited Bangladesh a year ago. He was a smoker of 10-15 cigarettes per day. He also admitted to smoking heroin. In addition to his respiratory symptoms he also complained of vomiting, which was precipitated by eating. He denied bowel or urinary symptoms.