FIG 1.

Summary of case presentation. (A) Abnormal computed tomography of the chest obtained on days 35 and 318 after diagnosis. (B) Brain abscess with surrounding edema on magnetic resonance imaging on day 83 and radiological improvement on day 344 after diagnosis. (C) Grocott’s methenamine silver stain (GMS; ×400 magnification) highlights numerous septate hyphae with acute angle branching, consistent with Aspergillus morphology, in the excised femoral artery. (D) The galactomannan trend and timeline for antifungal therapy are shown. Each dot represents a serum galactomannan level for the corresponding day after diagnosis. The red dotted line represents a positive galactomannan index cutoff (0.5). Note the persistently positive galactomannan for months prior to the addition of fosmanogepix and surgical excision of infected vascular tissues. Asterisks represent episodes of clinically significant cytomegalovirus reactivation (orange) and neutropenia with an absolute neutrophil count below 1,000 cells/mm³ (green), both known risk factors for invasive aspergillosis. Immunosuppressive medications for chronic graft-versus-host disease and various antifungal therapy agents administered are shown in color-coded bars below the x axis; the length of each bar corresponds to the duration of therapy.