A man with adult T-cell leukaemia (ATL) underwent massive spinal cord necrosis caused byAspergillus infection. Leukopaenia due to anti-cancer chemotherapy resulted in pulmonaryAspergillus infection. The aspergilloma was reduced in size by anti-fungal chemotherapy, but paraplegia occurred. At autopsy, the pulmonary aspergilloma was encapsulated and showed no contiguous extension of the infection to the epidural or subdural spaces or spinal cord. However, at the T5 level of the spinal cord, there was marked necrosis with haemorrhage caused byAspergillus infection, but without leukaemic cell infiltration of the spinal cord. Dichotomously branchingAspergillus hyphae filled the blood vessels of the T5 level of the spinal cord.