A 43-year-old man with no known comorbidities was hospitalized for respiratory failure and cardiogenic shock during influenza syndrome and was supported with the placement of Extra Corporeal Membrane Oxygenation (ECMO). A nasopharyngeal swab was performed, testing positive for the influenza B virus. During hospitalization, the patient developed pneumonia associated with pneumothorax and ischemia in the left lower limb. Radiography and Computerized Tomography of the chest revealed multiple diffuse thickenings and a severe degeneration of lung parenchyma. Repeated culture tests were performed from tracheobronchial aspirate and broncho-alveolar lavage (B.A.L.), testing positive (Figure 1) for A. fumigatus (A1) and A. niger (B1); B.A.L. and serum were also positive for galactomannan. The patient, treated with voriconazole and amphotericin B, progressively worsened and died one month after hospitalization. According to autopsy, the lungs appeared to have a preserved shape, but an increased volume and consistency. The parenchyma appeared congested and hemorrhagic, especially on the left, where there was parenchymal cavitation with erosion of the pleural surface. Microscopically (Figure 2), bronchiectasis (C) and broncho-pneumonic foci (D) with intra-alveolar macrophage collections and alveolar edema could be appreciated. In the left lung, a large necrotic-hemorrhagic cavitation communicating with the pleural cavity was observed (E) where a dense network of necrotic or morphologically preserved hyphae extended (F). The hyphae extended radially from a central focus, forming multiple microcolonies characterized by septate, constant caliber, parallel-walled hyphae with acute-angled dichotomous branches (Figure 3). From the histological preparations, stained with hematoxylin-eosin and with silver impregnation according to Grocott technique, Aspergillus heads were also found. Some monoseriate columnar heads showing phialides on the half or on the upper third of the vesicle were compatible with A. fumigatus (Figure 1A2) (Figure 4). Some radiate, biseriate heads presenting metulae and phialides along the entire surface of the vesicle were compatible with A. niger (Figure 1B2) (Figure 5). There are also foci of replacement fibrosis in left ventricular myocardium.