Invasive aspergillosis (IA) is a known sequel of severe immunosuppression and usually characterized by diagnostic difficulties because of low yield, sensitivity and specificity of positive respiratory culture results. IA is also associated with a mortality rate exceeding 80 per cent even with early detection and aggressive therapy.

Patients on immunosuppressive therapy for microscopic polyangiitis complicated by non-neutropenic sepsis are susceptible to IA. It is a huge challenge differentiating between a vasculitis flare and an invasive fungal infection. Early bronchoscopy for tracheal aspiration is the diagnostic test of choice. It may however be difficult to perform this invasive procedure in an unstable patient. Prophylactic fungal therapy is recommended in patients at high risk.

A high index of suspicion is pertinent as early therapy may still give a slim chance of survival in some patients. Only a few cases of IA complicating microscopic polyangiitis is reported in the literature. However, to the best of our knowledge there is no reported case of a rapid course with multi-organ failure as seen in this patient.