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A 46-year-old female with a history of diffuse large B-cell lymphoma status post autologous stem cell transplantation developed high risk MDS, which was thought to be secondary to her treatment. She had received induction chemotherapy with idarubicin, cytarabine and vorinostat (suberoylanilide hydroxamic acid) and was discharged. She was then readmitted to the hospital after developing fevers and diarrhea. After admission, she continued to be febrile despite broad-spectrum antibiotics and antifungal drugs. She had been on fluconazole prophylacatically and it was subsequently switched to posaconazole upon admission. While on the floor, she developed hemiplegia, hemineglect, dysarthria, mental status changes, and respiratory distress and was transferred to the intensive care unit. The chest x-ray showed bilateral pulmonary infiltrates and CT of the brain revealed multiple hypoattenuated lesions with associated marked edema scattered throughout the brain. Follow-up CT of the brain showed a mild midline shift. MRI of the brain reported multiple supratentorial and infratentorial masses producing ring-enhancing lesions that are centrally Brain Zygomycosis in a Patient with High Risk Myelodysplastic Syndrome after Initiation of Chemotherapy Sameh Gaballa, MD1 and Ali Al-Ameri, MD2 1 Thomas Jefferson University Hospital, Department of Internal Medicine; 2University of Texas MD Anderson Cancer Center