Fungal meningitis and intracerebral hemorrhage complicating prosthetic valve endocarditis

A 50 yr old man presented with meningitis 163 days following aortic valve replacement for congenital bicuspid aortic stenosis. One week later he died of intracerebral hemorrhage and autopsy revealed fungal prosthetic valve endocarditis. Colonies of branching septate hyphae were adherent to the oculomotor nerves and left posterior communicating artery. This pattern of fungal basal meningeal involvement complicating prosthetic valve endocarditis has not been previously described.