MS is a 59 year old diabetic patient requiring insulin. He had asthma since childhood, previous episodes of vasculitis, a retinopathy and renal dysfunction. In 1997 Mycobacterium avium intracellulare infection of the lung was diagnosed and successfully treated over a 12 month period. Shortly after this treatment was completed an aspergilloma was noted in the right upper lobe in September 1998. This was untreated for 2 years with progressive enlargement of the cavity most consistent with chronic necrotising pulmonary aspergillosis (CNPA), until the patient became unwell, when benefit from itraconazole was seen. Unfortunately the patient subsequently developed a squamous cell carcinoma and died.