Pneumothorax as the first symptom of pleural aspergillosis is a rare occurrence. Aspergillus spp. are ubiquitous fungi that are acquired by inhalation of airborne spores, causing a variety of clinical lung syndromes. The severity of lung aspergillosis depends on immune status and the presence of underlying lung disease. The manifestations range from invasive pulmonary aspergillosis in severely immunocompromised patients to chronic necrotizing aspergillosis in patients with chronic lung disease or mildly compromised immune systems. However, there is no consensus on the treatment for these rare cases. Surgical resection of infected lung tissue combined with a long-term antifungal agent can improve the prognosis for patients with the condition. Therefore, this case report presents a patient with recurrent pneumothorax that was infected by Aspergillus. The patient had a history of psoriasis 4 years ago with methotrexate treatment. After thoracotomy bullectomy procedure and a 12-week antifungal treatment, the condition showed significant improvement.