Lomentospora prolificans infective endocarditis and cerebral mycotic aneurysm

Disseminated <i>Lomentospora prolificans</i> infection typically occurs in immunocompromised hosts and is almost universally fatal. We describe a case of <i>L. prolificans</i> native valve infective endocarditis with cerebral mycotic aneurysm after recovery from allogeneic stem cell transplant. The case is notable for minimal immunosuppression at diagnosis, and pathological evidence of infection at sites which looked normal at surgery or by imaging. With early surgery and olorofim the patient survived to 76 days after diagnosis.