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Breakthrough infections can occur in high\u2010risk patients despite <jats:italic>Aspergillus<\/jats:italic>\u2010active antifungal prophylaxis. We describe a patient with rapid acute lymphoblastic leukemia (ALL) progression who presented with multifocal skin nodules thought to be choloromatous disease. These lesions were ultimately diagnosed as IF and the patient had two simultaneously active disease processes. This case highlights the importance of pathologic diagnosis of new skin lesions in ALL patients, even during leukemia progression, and demonstrates that IF can occur despite normal neutrophil counts and <jats:italic>Aspergillus<\/jats:italic>\u2010active prophylaxis.\u00a0\u00a0<\/jats:p>","DOI":"10.1002\/pbc.27732","type":"journal-article","created":{"date-parts":[[2019,3,22]],"date-time":"2019-03-22T12:17:50Z","timestamp":1553257070000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Invasive fusariosis masquerading as extramedullary disease in rapidly progressive acute lymphoblastic leukemia"],"prefix":"10.1002","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5513-1233","authenticated-orcid":false,"given":"John A.","family":"Ligon","sequence":"first","affiliation":[{"name":"Department of Pediatric Oncology Kimmel Cancer Center Johns Hopkins School of Medicine  Baltimore 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