A 26-year-old man, with a known case of hepatitis B, was referred to our hospital from the ENT clinic after a severe respiratory distress and hoarseness, which had occurred after an episode of upper respiratory tract infection (URTI). The condition was started 2 weeks earlier. His symptoms were started and exacerbated following URTI. He was treated with Cefixime, Theophyline and Salbutamule (inhaler) but the symptoms did not resolve. He did not have dysphagia or odynophagia, nor did carry any history of asthma, allergy, smoking or illegal substance abuse. His father had died of end stage stomach cancer about a year ago and his brother had vasculitis (who is under the treatment with corticosteroids). 
 Physical examination revealed fever (38.5 c). Examination of his mouth and oropharynx showed erythema and tonsilar hypertropthy without exudates in his oropharynx. He had an obvious inspiratory and expiratory stridor and overt respiratory distress. Auscultation of lung revealed diffused wheezing in his lungs with a 3/6 systolic murmur in his left sternal border and pulmonar area. There was no evidence of peripheral edema. Indirect laryngoscopic examination showed pappilomatose lesion in the 1/3 posterior portion of true vocal cords. There were maculopopular rashes on his chest wall, upper back, neck, face and extremities (Fig. 1). 
 Chest x-ray showed an increase in bronchovascular markings in middle and upper lobes of right lung. Lateral head and neck radiography revealed a mass in his subglottic area (Fig. 2-4). Chest CT-scan showed tubular bronchectatic changes at right lobe associated with pulmonary inflammation. Fibrotic band was seen at basal portion of both lungs with no pleural effusion. There was an aneurismal dilatation of aorta with maximum diameter of 50x48 mm in the ascending part and about 49x45 mm in the descending part. The ultrasound echocardiography confirmed the aortic aneurysm. Veneral disease research laboratory (VDRL), fluorescent treponemal antibody- absorption test (FT-ABS), antinuclear antibody (ANA), Cytoplasmic antineutrophil cytoplasmic antibodies (C-ANCA) and Perinuclear Anti-Neutrophil Cytoplasmic Antibodies (P-ANCA) were negative and angiotensin-converting enzyme (ACE) levels fallen within normal range.His rheumatoid factor was 3+ and C reactive protein 1+. His ESR level in the first hour was 54 mm/hr. Emergency trachestomy and mass debulking was done for emergency air way management. Direct laryngoscopy showed a 1.5 cm mass in subglottic area. Specimens were taken for culture and pathologic diagnosis. The throat cultures were negative for Mycobacterium tuberculosis and fungus. The specimen also contained multiple pieces of creamy-brownish soft tissue. The microscopic evaluation showed tissue composed of large cells with hyperchromatic round to ovaloid nuclei, prominent nuclei and irregular border and eosinophilic cytoplasm arranged as sheets. The immunohistochemistry report was positive for leukocyte common antigen (LCA), antigen KI-67 (60% of tumoral nuclei) and negative for CD3, CD20, CD43, CD30. The pathologic diagnosis was diffuse large cell lymphoma (High grade) and immunohistochemistry test for CD79 was positive which determined the B cell type. He had no symptom afterward.