A 54 year old smoker man comes with severe hemoptysis weight loss and oligoahritis. Serial skiagram shows fleeting opacities. What is the diagnosis?

Answer is A ( Allergic bronchopulmonary aspergillosis): The presence of fleeting opacities on serial skiagrams is consistent with a diagnosis of Allergic bronchopulmonary Aspergillosis and Wegner's granulomatosis. Associated Oligoahritis however ours a diagnosis of Wegener's granulomatosis which is the single best answer of choice. Oligoaicular Ahritis is a feature of Wegner's granulomatosis and is not mentioned as a feature of ABPA. Pauciaicular (oligoaicular) or Polyaicular ahritis may be seen in Wegner's granulomatosis'. - Current Rheumatology 2nd/276, 279 Presence of fleeting opacities may be seen in ABPA and Wegner's granulomatosis Fleeting opacities in ABPA Fleeting opacities in Wegner's `Patients with ABPA typically have 'Focal infiltrates which may be fleeting fleeting infiltrates on chest X-ray' are seen' -- Radiology of Chest Disease -- Crofton and Douglas Respiratory Diseases The presence of Oligoaicular ahritis and age of presentation our a diagnosis of Wegener's granulomatosis.