A 20-year-old woman with newly diagnosed B-cell lymphoproliferative syndrome was admitted to the intensive care unit with hypoxemic respiratory failure and septic shock during persistent SARS-CoV-2 infection. Despite rescue chemotherapy and broad-spectrum antimicrobial therapy, she developed aplasia and required mechanical ventilation, and venovenous extracorporeal membrane oxygenation (ECMO). On day 21, chest computed tomography showed progression of bilateral ground-glass opacities and consolidation (Fig. 1A and B). Flexible bronchoscopy friable mucosa with thick, cream-colored pseudomembranes and macroscopic white fungal colonies (Fig. 1C–F). Cultures and polymerase-chain-reaction testing of bronchial samples confirmed Aspergillus species, confirming invasive tracheobronchial aspergillosis.

Figure 1