Julie was 34y old when she was referred to the nutritional unit because of very severe weight loss and a history of inflammatory disease in several organ systems. At the age of 3 yr, she had a severe chest infection caused by aspergillus. A further episode occurred at 11 yr and a CT scan showed diffuse pulmonary fibrosis. An open lung biopsy at the referral hospital was reported as showing non-caseating granulomas attributed to extrinsic allergic alveolitis.