A 40 year old homosexual man with AIDS developed pneumonia caused by Pseudomonas aeruginosa and cytomegalovirus, which obscured the diagnosis of invasive pulmonary aspergillosis. He was receiving prednisolone for adrenal dysfunction, but at increased doses because of his multiple complicating factors including immune thrombocytopenia. He was hypoxic and his chest radiograph showed bilateral fluffy infiltrates. He developed gastro-intestinal haemorrhage and a gastric ulcer biopsy showed fungal hyphae. He then developed a detached retina and then the globe of his eye perforated. His bilateral pneumonia progressed and he died despite receiving amphotericin B.
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