A 45-year-old man, quarry worker for 23 years, diagnosed with complicated silicosis (PMF). Ex-smoker for 10 years (15 packets/year) and pulmonary tuberculosis (TBP) in 2000, correctly treated with recurrence in 2003. He had required frequent courses of steroids in the last 2 years. She presented to the emergency department for dyspnoea and haemoptotic expectoration of 5 months' duration. Physical examination showed febrile fever (37.3oC). Pulmonary auscultation showed rhonchi and bilateral wheezing. Blood tests showed haemoglobin 11.9 g/l; platelets: 515,000 / mm3; sedimentation rate 79 mm/h and C-reactive protein 50 mg/l. Arterial blood gases showed respiratory failure (pH 7.45, arterial oxygen pressure 59 mm Hg and arterial carbon dioxide pressure 35 mm Hg). Chest X-ray showed a bilateral micronodular pattern with clusters in both upper lobes. Computerised axial tomography (CT) revealed extensive bilateral interstitial involvement in relation to silicosis complicated by the formation of large masses of progressive massive fibrosis (PMF), which showed cavitation in their interior not present in the CT 9 months earlier, with mamelon formations in their interior at the level of the right upper lobe (LSD). Fibrobronchoscopy showed no significant findings and bronchoaspirate cytology showed no malignancy. Sputum lowestein culture was negative and fungal culture was positive for Aspergillus fumigatus. A CT scan showed that the cavitated lesion had shrunk in size after 7 months of treatment with voriconazole. The patient is currently being evaluated for lung transplantation.