<p>A 6.5 years old, intact male, Lagotto Romagnolo breed dog was referred to the Veterinary Teaching Hospital of the University of Perugia for severe anemia. The dog was in permanent lateral recumbency and, at physical examination, diffuse muscle hypotonia, weakness, lethargy, and pale mucous membranes were observed. The owner also reported a clinical history of right-sided head tilt and cervical and lumbosacral pain, unresponsive to anti-inflammatory and antibiotic therapy. Three months before clinical signs appeared, a nasal grass awn foreign body was removed. Non-regenerative anemia, neutrophilia, monocytosis, hypoalbuminemia, and increased C-reactive protein were found on complete blood count and biochemical analysis. On diagnostic imaging examinations, multi-organ disseminated lesions were detected and renal lesions were sampled by fine-needle aspiration. Cytological examination then uncovered fungal hyphae, which the culture identified as <i>Aspergillus fumigatus</i>. Therapy with itraconazole was administered and led to the successful resolution of the anemia and a good control of clinical signs, although nine months later it was discontinued due to the onset of impaired renal function. Despite a subsequent relapse, the dog responded positively to antifungal therapy even at its second administration and at the time of writing, was still alive and in partial clinical remission more than fifteen months after diagnosis.</p>