A 51 year old immunocompetent man was admitted to the intensive care unit with severe acute respiratory distress syndrome caused by influenza A infection. He initially responded well to treatment. His respiratory status subsequently deteriorated and he developed multi-organ failure which prompted suspicion of either a bacterial or fungal co-infection, a recognised complication of influenza infection. Bronchoscopy revealed multiple pseudomembranes in the trachea (Fig. 1) and right and left main bronchi. Samples from brushings and bronchoalveolar lavage were sent to the laboratory. Culture of these yielded both Aspergillus flavus and Aspergillus fumigatus (Fig. 2). Unfortunately despite appropriate treatment the patient progressed to refractory multi-organ failure and died.

Figure 1

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Figure 2

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