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Aspergillus fumigatus is a ubiquitous fungus associated with a variety of clinical syndromes. We report a case in which a patient with neurosarcoidosis but no underlying lung disease developed disseminated aspergillosis after starting infliximab therapy. CASE PRESENTATION: A 57 year old man with neurosarcoidosis on dexamethasone, infliximab, and methotrexate presented with two week history of shortness of breath and night sweats and one day history of right eye vision loss. Chest CT revealed new 3.6 cm cystic lung mass and three solid pulmonary nodules. MRI brain revealed innumerable ring-enhancing lesions in the right inferior frontal lobe measuring up to 3.7 cm. MRI spine revealed interval resolution of previously biopsied spinal granulomatous lesions. CSF studies and cultures were unremarkable. Serum Fungitell was > 500. Vitreous fluid culture from right eye and tissue culture from lung mass revealed Aspergillus fumigatus. The patient was treated with voriconazole.

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