CASE PRESENTATION: A 62 year old female with Waldenstrom’s macroglobulinemia on carfilzomib, rituximab, and dexamethasone presented to the hospital after routine outpatient blood work revealed acute kidney injury. On admission, she had no complaints. Creatinine (Cr) was 2.8, white blood cell count was 1.8, and absolute neutrophil count (ANC) was 1530. Cycle 3 of chemotherapy was given on day 3 as per original schedule. ANC fell below 500 by day 5 and remained <500 for rest of hospitalization. Course was complicated by worsening Cr requiring hemodialysis on day 13. She also became newly confused on day 18. CT head on day 18 did not show any abnormality. CT chest showed bilateral upper lobe opacities and a 8.3 mm left upper lobe nodule. DWI sequences on MRI brain (day 19) showed bilateral foci of restricted diffusion in anterior and posterior circulation (Fig. 1). GRE images shows right frontal hemorrhage (Fig. 2). Due to unresponsiveness, she was intubated on day 20 and underwent bronchoscopy with bronchoalveolar lavage with final culture growing Aspergillus fumigatus. On day 25, as serum Aspergillus antigen came back positive at an index of 6.22 and serum (1,3)-beta-D-glucan came back positive at >500 pg/mL, voriconazole was started. Per her original wishes, as she did not improve, she was later made comfort care.