This three-year-old child initially presented with sub-acute respiratory symptoms, fever, weight loss and right upper lobe opacification. Pulmonary tuberculosis was considered because it is endemic in our country. TB diagnosis is difficult in children and frequently relies on an algorithm relying on characteristic history, typical clinical signs and suggestive radiograph findings. When the child failed to respond to anti-tuberculous therapy and developed the chest wall mass with draining sinuses, invasive fungal infection was considered including invasive aspergillosis and actinomyces. The incidence of invasive aspergillosis in developing countries is not known due to limited diagnostics and paucity of data. Data for the paediatric population are even more scarce, as most of the reported cases are in adults. The commonest risk factor is a cavitary lung lesion, which in developing countries is often due to tuberculosis. There are reports of aspergilloma occurring in the context of chronic cavitary pulmonary aspergillosis. Most cases of invasive aspergillosis in developing countries are due to Aspergillus fumigatus, which is ubiquitous and thrives in a hot, humid environment. The environmental load of conidia is increased by construction or renovation. The respiratory tract is the usual port of entry and the most common site of infection. The host's immune status influences the extent of mycelia colonization and tissue invasion. Risk factors include neutrophil defects, prolonged neutropenia, high dose corticosteroids, immunosuppressants, bone marrow and solid organ transplants. Newly recognized risk factors are reactive airway disease and allergic bronchopulmonary aspergillosis. Antibiotics are a recognized risk factor for fungal infection, and third generation cephalosporins, carbapenems and glycopeptides in particular have been associated with increased risk of developing invasive aspergillus sp. infection. This child did not demonstrate a clinical pattern consistent with congenital or acquired immune deficiency, nevertheless a deeper evaluation including neutrophil function would have been warranted. The presenting symptoms and radiological features may be indistinguishable from tuberculosis, and diagnosis may rely on histology as in our case. The drug of choice for treatment of invasive aspergillosis is voriconazole, which has been proven to be safe and effective in children. It is an expensive drug that is not readily available, and the patient was started on amphotericin B, as his renal function was normal. Early surgical intervention is recommended for some invasive pulmonary aspergillosis patients as it reduces the fungal burden and shortens the duration of antifungal therapy.