Abstract
There is an increased risk of invasive aspergillosis (IA) during the induction of acute lymphoblastic leukemia (ALL) because of the use of cytoreductive chemotherapy and high-dose steroids. This case demonstrates the utility of metagenomic next-generation sequencing and repeat sampling in clarifying complex infections and highlights blinatumomab as an effective antileukemic option when conventional chemotherapy is limited by active infection. Together, these strategies enabled the successful management of refractory ALL in a patient with pulmonary IA and fungal DNAemia.