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A woman in her 50s with a history of bronchial asthma for which she was not on any specific treatment presented to the pulmonology outpatient department with complaints of cough with mucoid expectoration and occasional scanty haemoptysis for the past 3 years. Three years prior to her presentation to our institution, she was evaluated with CT of the chest, which showed cavitation and bronchiectasis in the right upper and lower lobes. Cartridge-based nucleic acid amplification test for Mycobacterium tuberculosis was negative; however, antituberculous therapy was initiated empirically. Three months later, in the absence of clinical improvement, a repeat CT of the chest was performed, which showed worsening consolidation and cavitation. Bronchoscopy was performed, and bronchoalveolar lavage was negative for mycobacterial, bacterial and fungal organisms. A CT-guided biopsy of the lung lesion was advised, but the patient opted to continue only medical management. She was discharged on a short course of oral antibiotics (amoxicillin/clavulanate 625 mg) for 7 days. Repeat chest imaging 1 month later showed minimal radiological clearance. She then presented to our centre 6 months after this last evaluation. On presentation to our institution, she reported increased cough and mucoid expectoration, breathlessness with wheeze and right-sided chest and back pain. She had also experienced low-grade fever for 3 weeks, loss of appetite and a weight loss of 4 kg. CT of the thorax showed high attenuation mucus plugs in the apical and anterior segment of the right upper lobe, with saccular bronchiectasis noted in the superior segment of the right lower lobe (figure 1). Blood investigations showed peripheral eosinophilia (17.7%), elevated total serum IgE (1638 IU/mL), elevated Aspergillus fumigatus-specific IgE (21 kU/L) and elevated A. fumigatus-specific IgG (279 mg/L). Bronchoscopy was performed to exclude tuberculosis and underlying malignancy, given the history of fever and weight loss. Thick tenacious mucus plugging (figure 2) was seen in all segments of the right upper lobe. Bronchoalveolar lavage revealed budding yeast cells with pseudohyphae, and cytology showed abundant mucin with neutrophilic exudate and evidence of fungal organisms. Fungal culture, however, was negative. Based on the above clinical, serological, cytological and radiological findings, a diagnosis of allergic bronchopulmonary aspergillosis (ABPA) was established in accordance with the International Society for Human and Animal Mycology (ISHAM) guidelines. The patient was treated with itraconazole and a tapering course of oral prednisolone. At the 6-month follow-up, she demonstrated symptomatic improvement with a significant reduction of wheeze and expectoration. ABPA occurs due to heightened sensitivity to A. fumigatus colonisation. It presents with refractory bronchial asthma, recurrent pulmonary infiltrates and central bronchiectasis.1 2 A distinctive radiological feature is high-attenuation mucus (HAM), which is intraluminal mucoid material that appears radiodense (>70 Hounsfield units) on CT due to enrichment with fungal metabolic byproducts, including mineralised calcium and transition metals such as iron and manganese.3–5 HAM is associated with an increased risk of disease recurrence and is recognised as a distinct phenotypic variant within contemporary ISHAM radiological classification systems.6 However, identification of HAM does not necessitate modification of established therapeutic protocols, which remain based on conventional antifungal and corticosteroid regimens.