A patient with systemic lupus erythematosus (SLE), a chronic autoimmune disease treated with long-term immune-suppressing medications, developed a serious fungal lung infection called pulmonary aspergilloma. Despite the complexity of managing multiple conditions and extensive bilateral lung involvement, the patient was successfully treated with prolonged voriconazole antifungal therapy rather than surgery, emphasizing the importance of early recognition and tailored treatment in immunocompromised patients.