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A 53-year-old man with acute promyelocytic leukaemia was admitted to the intensive care unit due to progressive dyspnoea and haemoptysis over 1 week. He had no history of diabetes. 3 weeks ago, he underwent chemotherapy with all-trans retinoic acid and arsenic trioxide and received prophylactic posaconazole 300 mg orally every day for antifungal coverage during neutropenia. The physical examination was unremarkable except for the stridor at rest and decreased breath sounds of the right lung. Thoracic CT scan revealed unilateral lung consolidation involving the right upper and middle lobes, without prominent reversed halo sign (figure 1A,B). The patient was promptly intubated and received mechanical ventilation. Subsequently, severe bleeding was observed in the bilateral endobronchial regions. After blood suctioning, necrotic growth was identified at the openings of the right upper and middle lobes. 4 days later, the third bronchoscopy revealed that fungal hyphae had obstructed the opening of the right middle lobe, and a portion of the necrotic growth was removed during the procedure (figure 1C,D). Once the necrotic material was partially cleared, the underlying bronchial appeared to have diffuse necrosis (figure 1E). Microscopic examination of protected specimen brush using immunofluorescence staining (figure 1F) confirmed mycotic structures, and fungal culture grew Rhizopus microsporus.1 Histopathology demonstrated broad, aseptate, right-angle branching fungal hyphae consistent with morphology of mucor (figure 1G). No evidence of Aspergillus infection was detected in either the second-generation gene sequencing, the fungal culture or the galactomannan test of the bronchoalveolar lavage fluid.