Echoes of infection: radial EBUS unveils invasive pulmonary aspergillosis.

Invasive fungal disease commonly affects immunocompromised hosts and rarely immunocompetent individuals. The disease carries high mortality, making early diagnosis and initiation of treatment crucial in the management. Diagnosis is based on host, clinical, mycological and histological factors. Bronchoscopy, especially radial endobronchial ultrasound (REBUS), is a widely used technique in the evaluation of peripheral pulmonary lesions. Here, we present an interesting case of an elderly man in his late 60s with pemphigus foliaceus on immunosuppressants who presented with fever and cough for 1 week, with CT of the chest showing consolidations in both lungs. REBUS-guided biopsy from the right upper lobe with bronchoalveolar lavage revealed the diagnosis of invasive pulmonary aspergillosis. The patient improved with the initiation of antifungal therapy. This case highlights the importance of REBUS-guided targeted sampling of lung while suspecting invasive fungal infections.