VAPA strikes the patient again!

Viral associated pulmonary aspergillosis (VAPA) is increasingly being recognized by clinicians. However, the same patient developing VAPA after two separate viral respiratory illness appears to be rare. We describe a patient who developed influenza associated invasive aspergillosis (IAPA) which resolved completely with treatment. A second episode of VAPA developed after one year following human rhinovirus/enterovirus with a nodular infiltrate at a different location in the lungs as compared to earlier. Neither episode required ICU admission and both episodes were treated successfully.