lymphohematogenous

— When these responses fail, lymphohematogenous dissemination may develop.[ 2 ] Unlike other opportunistic infections, the likelihood of infection with B. dermatitidis is equal among immunocompetent and immunosuppressed individuals.[ 2 ] However, infection does tend to be more aggressive in people with compromised cellular immunity.[ 2 ] Lymphatic and hematogenous spread may ensue to potentially any organ.[ 4 ] After lungs, other sites of disease involvement include skin, bone, genitourinary system, and the CNS, in order of decreasing frequency.[ 2 ] CNS involvement is seen in 5–10% of disseminated blastomycosis cases.[ 2 ] CNS blastomycosis without evidence of pulmonary or other organ system involvement, such as in the patient presented here, is a rare occurrence.