Over the next year, his local physician lowered his prednisone dose to 5 mg daily while the patient continued to receive infliximab. After 3 months on this low prednisone dose, the patient returned (July 2008) complaining of dyspnea and wheezing that had worsened over several weeks. These symptoms had occurred within 24 h after his previous infliximab infusion. He had no recurrence of lupus pernio skin lesions, SURT symptoms, or eye problems. He also complained of coughing up “bronchial casts.” His physical examination was only remarkable for wheezing on chest auscultation. His pulmonary function is displayed in Table 1. Blood test results revealed the following: WBC count, 6,290/mm3 with 10% eosinophils; serum IgE, 8,319 IU/mL; aspergillus-specific IgE, 55.6 kU/L (highly positive; normal, < 0.05 [Labcorp; Burlington, NC]); and aspergillus-specific IgG, 5.59 kUA/L (highly positive; normal, < 0.05 [Labcorp; Burlington, NC]). A chest CT scan showed mediastinal lymphadenopathy and scattered small alveolar opacities but no bronchiectasis. Even without the presence of bronchiectasis, the diagnosis of ABPA is secure serologically.10 His prednisone dose was raised to 20 mg daily with resolution of his symptoms within 2 weeks. However, even with this prednisone dose, 24 h after his next infliximab infusion he noted recurrent wheezing and a cough productive of bronchial casts that continued for 1 week.