A 47-year-old male worker with a history of tongue cancer after radical operation with neck dissection and concurrent chemotherapy in 2014 came to our hospital presenting with right anterior chest pain and hemoptysis that had lasted for 1 month. No immunosuppressive medical history was shown for nearly 5 years before his first clinic visit and hospitalization, and after his last chemotherapy in 2014 for tongue squamous cell carcinoma. Moreover, his fasting blood sugar levels were within normal limit during every clinic visits. He denied having fever, dyspnea, dysphagia or abdominal pain. Chest radiography showed a right upper lobe (RUL) cavitary lesion and two cystic lesions within the bilateral upper lung field (Figure 1a). Chest computed tomography revealed a cavity with a ball-in-hole lesion in the RUL and two small cystic lesions in the bilateral upper lobes (Figure 1b and c). The first endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB) from the RUL anterior segmental bronchus (RB3) revealed the presence of Aspergillus conidia (Figure 2a and b). Aspergillus fumigatus was isolated from the bronchoalveolar lavage culture, and a serum Aspergillus galactomannan antigen test was found to be positive. Moreover, the histopathological examination of the biopsy also revealed the presence of squamous cell carcinoma (through immunohistochemical positivity for p40 and p53 and negativity for TTF-1), which was concurrent with aspergillosis (Figure 2c and d). The patient also received diagnostic wedge resection for the cystic lesion of the left upper lobe to differentiate between the fungal infection and the malignancy. Histopathology confirmed the diagnosis of metastatic squamous cell carcinoma based on clinical history and cell morphology. A final diagnosis of metastatic squamous cell carcinoma concurrent with Aspergillus fumigatus in the lung was made. Empirical voriconazole therapy for pulmonary aspergillosis was administered for nearly 2 months. Following voriconazole treatment, the serum Aspergillus galactomannan antigen test was negative, and no evidence of pulmonary aspergillosis in sequential bronchoalveolar lavage was found. Subsequent chemotherapy with cisplatin and docetaxel was undertaken for the treatment of the patient's pulmonary squamous cell carcinoma. The latter resulted in the partial remission of pulmonary lesions, as confirmed at follow-up (Figure 3(a-c)).