Chronic pulmonary aspergillosis (CPA) is a progressive, debilitating infection associated with substantial
morbidity and mortality. Diagnosis may be missed because of the non-specific symptoms and poor sensitivity
of culture. Oral antifungals offer an improvement in quality-of-life parameters, but prolonged treatment is
often required as recurrences are common. Prolonged antifungal treatment is associated with high cost and
an extensive side effect profile frequently leading to discontinuation. In addition, resistance developing
during treatment is a common problem that limits our therapeutic options. Challenging CPA cases will be
presented, and the step-by-step management will be discussed, focusing on the difficulties in recognition,
diagnosis and treatment.