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Histoplasmosis - CNS Involvement: Involvement of the central nervous system is rare and is seen in the setting of disseminated histoplasmosis. The spread is usually from a pulmonary focus. The risk factors include immunosuppression (HIV, steroids, post-organ transplant), burns, antiobiotic therapy, and treatment with TNF-α. CNS histoplasmosis usually results in basilar or diffuse meningitis. Intraparenchymal lesions (shown here) also occur and can mimic neoplasms.