59 year old male with a history of non-ischemic cardiomyopathy, status post AICD/pacemaker insertion, presented with generalized weakness and confusion. He was diagnosed with diffuse B-cell lymphoma and underwent bone marrow transplant about a year ago.

The patient was on Warfarin (Coumadin) for his cardiomyopathy. Three days prior to admission he fell in the bathroom and hit his head. On presentation to the Hospital his INR was elevated at 4.1 with the platelet count of 17,000 (normal>150,000). He had low grade fever and normal white count. Cultures were obtained.

CT head showed a lesion in the right frontal area. MRI is not possible due to the AICD. CT Chest revealed multiple pulmonary nodules (see the image above).

The patient is a farmer and was working with hay several days prior to admission. He was started on an antifungal agent (voriconazole) for possible fungal infection. Bronchoscopy and biopsy was scheduled.

What is the likely etiology of the lesion in the brain and in his lungs?