Invasive aspergillosis (IA) primarily affects immunocompromised patients, with Aspergillus granulosus being a rare cause. Most cases occur in transplant recipients, and breakthrough infections may develop after azole therapy due to cryptic species and antifungal resistance. Here, we present the first non-transplant case of breakthrough A. granulosus infection following azole therapy with a fatal outcome. This case highlights the importance of early diagnosis, accurate species identification, and appropriate antifungal treatment for breakthrough invasive fungal infections. • Aspergillus granulosus is a rare cause of invasive aspergillosis (IA). • It can lead to breakthrough IA after azole therapy. • Its cryptic phenotypes and antifungal resistance challenge the management. • Early diagnosis with appropriate antifungal therapy is crucial to improve outcomes.
Jaroensawang et al. (Sun,) studied this question.