Her posttransplant course was complicated by the development of a native lung aspergilloma requiring right-upper lobectomy at 33 weeks posttransplant. Persistence of aspergillus growth in BAL fluid necessitated long-term oral itraconazole treatment at a dose of 200 mg bid. Surveillance bronchoscopies had revealed two episodes of A1B0 rejection that were untreated as well as one episode of A2B0 rejection, treated with an augmented oral prednisone dose. Bronchoscopy 2 months prior to presentation revealed no aspergillus or rejection. Her medications included tacrolimus (3 mg bid), prednisone (5 mg qd), azathioprine (50 mg qd, dose limited by low WBC count), acyclovir, omeprazole, conjugated estrogen, pravastatin, metoprolol, trimethoprim/sulfamethoxazole, magnesium oxide, iron sulfate, calcium, and vitamin D.