With nuchal rigidity, elevated WBC counts, bandemia, elevated erythrocyte sedimentation rate and C-reactive protein level, positive bacterial culture results, and widespread multiorgan lesions, disseminated infection is a clear consideration. Specifically, disseminated Mycobacterium tuberculosis is a concern because of features of lung nodules, mediastinal lymphadenopathy, back pain with vertebral body fracture (Pott disease), and miliary lesions in the posterior fossa. Similarly, many systemic fungal infections, such as aspergillosis, blastomycosis, histoplasmosis, coccidiomycosis, and mucormycosis, also affect the lung, brain, kidney, bone, skin, and other organs. Both M tuberculosis and fungal infections may present with severe headache, cranial nerve palsy, and signs of increased intracranial pressure; CSF analysis typically reveals a lymphocytic pleocytosis (lymphocyte count up to 1000/μL [to convert to ×109/L, multiply by 0.001]), an elevated protein level (0.1-0.8 g/dL), and a decreased glucose concentration. The classic neuroimaging pattern includes basal cistern meningeal enhancement, posterior fossa cerebral abscesses, and hydrocephalus.2,3 This patient had enhancing parenchymal and meningeal lesions within the posterior circulation but no clear history of exposure to M tuberculosis or fungus. Neither headache nor cranial nerve palsy was initially present, and initial CSF results were not supportive of the diagnosis. Definite diagnosis of central nervous system (CNS) M tuberculosis or fungal infection requires isolation of M tuberculosis or a fungus from the CSF or the brain tissue by histologic identification.