The respiratory situation improved marginally in the subsequent 7 days but declined steadily thereafter. Pressure support and pressure control ventilation were alternated between days 12 and 19 and attempts to return the patient to a supine position failed several times. After 7 days, A. fumigatus grew on the itraconazole and voriconazole wells of the second VIPcheck on day 19 (tracheal aspirate culture). MICs of this A. fumigatus isolate were as follows: amphotericin B 0.5 mg/L, anidulafungin and micafungin <0.016 mg/L, itraconazole 16 mg/L, voriconazole 2 mg/L and posaconazole 0.5 mg/L. Voriconazole treatment was changed to liposomal amphotericin B 200 mg q24h. Subsequent cyp51A gene sequencing identified a TR34/L98H mutation, probably responsible for the observed azole resistance. On day 22, ventilation and oxygenation of the patient deteriorated further without further treatment options and therapy was discontinued on day 23. An autopsy was not performed.