A 37-year-old Japanese woman with a past medical history of aortic valve replacement secondary to a congenital aortic aneurysm and presumed Takayasu's arteritis treated with prednisone (60 mg daily) presented to the inpatient service with shortness of breath, abdominal pain, and leg and foot pain. The patient had a 9-month history of repeated emboli and fevers. Due to the concern for an unidentified source of the emboli, a computed tomography angiography (CTA) of the chest was conducted, revealing a moderately sized pseudoaneurysm arising from the posterior margin of a previously performed ascending aortic graft and filling defects concerning for thrombi in the distal ascending aorta/proximal aortic arch near the graft anastomosis. The patient was started empirically on broad-spectrum antimicrobials consisting of intravenous vancomycin (750 mg every 12 h [q12h]), piperacillin-tazobactam (3.37 g q8h), and voriconazole (200 mg q12h).The patient underwent thrombectomy and resection of ascending aortic graft tissues, portions of which were submitted for histopathological and microbiological analysis. Histopathologic examination of the ascending aortic tissue and left iliac artery embolus and thrombus utilizing hematoxylin and eosin (H&E) stain, Gomori methenamine silver (GMS) stain, and periodic acid-Schiff stain (PAS) revealed numerous septate hyphae with dichotomous branching (Fig. 1). Based on this finding, voriconazole therapy was continued and converted to oral voriconazole (360 mg q12h) postextubation to cover suspected aspergillosis. The diagnosis of Takayasu's arteritis was dismissed as the etiology of the patient's aneurysm, and the patient's regimen of prednisone was discontinued. Blood cultures were negative throughout her hospitalization.After 3 days of incubation at 30°C, mold growth was observed on brain heart infusion agar and Sabouraud dextrose agar with chloramphenicol. The colony surface was at first white and glabrous and then became powdery and light brown with a light tan periphery (Fig. 2). The reverse was tan with a brownish center. Microscopic examination of tape preparations from the mold colony revealed septate hyphae giving rise to short conidiophores which bore annellides mostly arranged in brushlike groups. Conidia were 5 to 8 m in size, round, light brown in color, and with truncated bases (Fig. 2). Based on the colony and microscopic morphologies, the identification was most consistent with Scopulariopsis brevicaulis. Definitive species-level identification based on molecular testing was beyond the scope of this study; accordingly, the final identification was made at the genus level.Following reporting of these findings, the antibacterial therapy was discontinued after a total of 4 days and intravenous amphotericin B (65 mg q24h) was added to the Citation Arroyo MA, Walls TB, Relich RF, Davis TE, Schmitt BH. 2017. The Brief Case: Scopulariopsis endocarditis-a case of mistaken Takayasu's arteritis. J Clin Microbiol

ANSWERS TO SELF-ASSESSMENT QUESTIONS Which risk factor is associated with fungal endocarditis?A. Asian ethnicity B. Young age (Յ40 years) C. Aortic valve replacement D. Female gender Answer: C. Fungal endocarditis is most common in patients who are immunocompromised, intravenous drug abusers, recipients of prolonged antibiotic therapy, recipients of parenteral nutrition, and recipients of prosthetic heart valves and in those who have undergone reconstructive cardiac surgery. Asian ethnicity, young age (10 to 40 years), and female gender are risk factors associated with Takayasu's arteritis. What histopathological features are indicative of hyalohyphomycosis?A. Broad, pigmented, septate hyphae B. Broad, hyaline hyphae with sparse septations C. Narrow, septate hyphae without melanin pigmentation D. Narrow, pigmented, septate hyphae Answer: C. Hyalohyphomycosis is a fungal disease caused by a variety of molds that produce hyaline, septate, and mostly narrow hyphae that range from 2 to 6 m in width. The hyalohyphomycetes group includes Aspergillus spp., Fusarium spp., Scedosporium spp., and others. Mucoraceous molds produce hyaline hyphae, but they are usually broader (5 to 25 m in width) and have sparse or no septae. In contrast, phaeohyphomycoses are caused by phaeoid fungi that produce pigmented, narrow, and septate hyphae. Examples of phaeoid fungi include Alternaria spp., Curvularia spp., and Bipolaris spp., among others.3. The following statement is true regarding the antifungal susceptibility profile of Scopulariopsis brevicaulis.A. Always susceptible to micafungin and posaconazole B. Multiresistant to broad-spectrum antifungal agents C.