BACKGROUND: Aspergillus spores have the ability to affect patients with or without intact immune systems; because of this disease’s wide patient involvement it deserves a place on the differential diagnosis list, with endocarditis and tuberculosis, for those presenting with new pulmonary nodules or cavitation.

CASE REPORT: This case report involves the presentation, diagnosis, and treatment of a 69-year-old female who presented with new rapidly progressing cavitary lung lesions in the setting of copious administration of systemic steroid use. Given the patient’s past history of alcoholism and environmental exposure, her case was not straight forward in regard to a diagnosis. Ultimately, she was diagnosed with chronic cavity pulmonary aspergillosis in the setting of chronic immunosuppression secondary to systemic steroid administration. Due to her convoluted medical history and the poor differential diagnosis list, there was a delay in final diagnosis.

CONCLUSIONS: This case report and clinical review aims to prevent anchoring when the patient’s presentation is not straight forward and aims to remind the clinician of the importance of a differential diagnosis.

Keywords: Aspergillosis, Allergic Bronchopulmonary, invasive pulmonary aspergillosis, Pulmonary Disease, Chronic Obstructive, Alcoholism, Aspergillus fumigatus, Carcinogens, Chronic Disease, delayed diagnosis, Diagnosis, Differential, Glucocorticoids, Occupational Exposure, pulmonary aspergillosis, Tetrachloroethylene, Tomography, X-Ray Computed