Case number: 42Summary: Patient had CCPA with an intraluminal fungal ball at the time of his initial resection surgery, without tissue invasion. However, six months later CCPA developed again manifest as a new cavity in previously uninvolved lung and a percutaneous biopsy was positive for Aspergillus. This was a ‘new infection' as his chest X-ray after surgery documented complete clearance. He did not respond completely to oral itraconazole or voriconazole, but did with intravenous amphotericin, combined with growth factors. He has remained stable on itraconazole over a 13 year period (10/09), but on the occasions therapy has been discontinued he has relapsed rapidly. Keywords: CCPA, Fungal ball, itraconazole, surgery.