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The mixed form of bIFIs is a rare phenomenon but could be potentially a troublesome challenge when caused by azole-resistant strains or non-<jats:italic>Aspergillus fumigatus<\/jats:italic>. To raise awareness and emphasize diagnostic challenges, we present a case of mixed bIFIs in a child with acute lymphoblastic leukemia.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A newly diagnosed 18-month-old boy with acute lymphoblastic leukemia was complicated with prolonged severe neutropenia after induction chemotherapy. He experienced repeated episodes of fever due to extended-spectrum beta-lactamase-producing <jats:italic>Escherichia coli<\/jats:italic> bloodstream infection and pulmonary invasive fungal infection with <jats:italic>Aspergillus fumigatus<\/jats:italic> (early-type bIFIs) while receiving antifungal prophylaxis. Shortly after pulmonary involvement, his condition aggravated by abnormal focal movement, loss of consciousness and seizure. Cerebral aspergillosis with <jats:italic>Aspergillus niger<\/jats:italic> diagnosed after brain tissue biopsy. The patient finally died despite 108-day antifungal therapy.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Mixed bIFIs is a rare condition with high morbidity and mortality in the patients receiving immunosuppressants for hematological malignancies. This case highlights the clinical importance of <jats:italic>Aspergillus<\/jats:italic> identification at the species level in invasive fungal infections with multiple site involvement in the patients on antifungal prophylaxis.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12879-020-05162-9","type":"journal-article","created":{"date-parts":[[2020,7,23]],"date-time":"2020-07-23T09:03:53Z","timestamp":1595495033000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Cerebral and pulmonary aspergillosis, treatment and diagnostic challenges of mixed breakthrough invasive fungal infections: case report study"],"prefix":"10.1186","volume":"20","author":[{"given":"Ali","family":"Amanati","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehrzad","family":"Lotfi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Sadegh","family":"Masoudi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadis","family":"Jafarian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatemeh","family":"Ghasemi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haleh","family":"Bozorgi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4221-2995","authenticated-orcid":false,"given":"Parisa","family":"Badiee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,7,23]]},"reference":[{"issue":"2","key":"5162_CR1","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1148\/rg.292075143","volume":"29","author":"BM Almutairi","year":"2009","unstructured":"Almutairi BM, Nguyen TB, Jansen GH, Asseri AH. 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The study protocol conformed to the ethical guidelines of the 1975 Helsinki Declaration.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patients\u2019 parents o for publication of this case report and any accompanying images.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"535"}}