Invasive fungal sinusitis and meningitis due to Arthrographis kalrae in a patient with AIDS

We report the first described case of Arthrographis kalrae pansinusitis and meningitis in a patient with AIDS. The patient was initially diagnosed wit h Arthrographis kalrae pansinusitis by endoscopic biopsy and culture. The p atient was treated with itraconazole for approximately 5 months and then di ed secondary to Pneumocytis carinii pneumonia. Postmortem examination revea led invasive fungal sinusitis that involved the sphenoid sinus and that ext ended through the cribiform plate into the inferior surfaces of the bilater al frontal lobes. There was also an associated fungal meningitis and vascul itis with fungal thrombosis and multiple recent infarcts that involved the frontal lobes, right caudate nucleus, and putamen. Post mortem cultures wer e positive for A. kalrae.