Triple Calamity in a Smoker: Idiopathic Pulmonary Fibrosis, Chronic Pulmonary Aspergillosis, and Lung Adenocarcinoma.

We report, to the best of our knowledge, the first case of idiopathic pulmonary fibrosis (IPF) with concomitant chronic pulmonary aspergillosis (CPA) and lung adenocarcinoma in a 62-year-old male smoker. The patient presented with a dry cough for three years and intermittent hemoptysis for the last year. The radiological evaluation suggested IPF and bilateral lung masses with an air-crescent sign, which progressively increased in size. Subsequent investigations, including bronchoscopy and transthoracic biopsy, confirmed the presence of the triple calamity of IPF, CPA, and lung cancer. He was managed with antifungal, antifibrotic, and systemic chemotherapy following a multidisciplinary discussion. This rare coexistence highlights the complex diagnostic and therapeutic challenges in patients with IPF presenting with new cavitary or progressive lesions.