A 4-year-old female spayed Golden Retriever was evaluated after generalized seizures for 2 days and a 1-month history of decreased appetite, conjunctivitis in the left eye (OS), and pyoderma. Therapy with oral cephalexin (25.6 mg/kg PO q12h), neopolydex ophthalmic solution (OS q6h), and oral phenobarbital (1.6 mg/ kg PO q12h) did not improve clinical signs. Physical examination revealed multifocal nodular skin lesions, granulomatous fundic lesions in both eyes (OU), and uveitis OS. Neurologic examination abnormalities included an absent menace response and direct pupillary light reflex OS, delayed conscious proprioception in all limbs and generalized ataxia. Neuroanatomic localization was forebrain.CBC and serum biochemistry profile results were within reference intervals. On thoracic radiographs, a bilateral interstitial pulmonary pattern was present in the caudal dorsal lung fields with a round, soft tissue opacity (2.5 Â 2 cm) in the left caudal lung.Magnetic resonance imaging (MRI) of the brain was performed with a 1.0 T magnet.a Images included T2-weighted (T2W), fluid-attenuated inversion recovery (FLAIR), and T1-weighted (T1W) images before and after intravenous contrast administration (0.1 mmol/kg gadodiamide).b Multifocal intra-and extra-axial lesions causing a mild left midline shift were identified in the right cerebrum, thalamus, and midbrain). Lesions were also present in the left ocular posterior chamber and temporalis muscles adjacent to affected brain region. Brain lesions were hypointense to grey matter on T1W images and mildly hyperintense with marked perilesional edema on T2W and FLAIR images. After contrast administration, there was enhancement of lesions and meninges (Fig 1). Radiological diagnosis was multifocal brain disease with secondary meningitis and left ocular granuloma or retinal hemorrhage.Cisternal cerebrospinal fluid (CSF) analysis showed 15 white blood cells/mL (reference range, 5), 2 red blood cells/mL, and 25.9 mg/dL protein (reference range, 25). The differential cell count was 30% neutrophils, 60% lymphocytes, and 10% macrophages. CSF immunoflourescence antibody titer (IFAT) for Neospora caninum was 10 (reference, !10 positive).Microscopic examination of an aspirate of the pulmonary mass showed pyogranulomatous inflammation and Blastomyces dermatitidis organisms. Disseminated blastomycosis was presumptively diagnosed and the dog was treated with fluconazole (5 mg/kg PO q12h); phenobarbital (2.5 mg/kg PO q12h), cephalexin (20 mg/ kg PO q12h), and neopolydex (OU q8h) were continued.The dog represented for examination because of acute obtundation 2 weeks later. Inflammation secondary to death of Blastomyces organisms in the central nervous system (CNS) was suspected. After therapy of dexamethasone sodium phosphate (0.07 mg/kg IV once) and prednisone (0.25 mg/kg PO q12h), the dog's clinical signs rapidly improved. Clindamycin (10 mg/kg PO q12h) was added based on a N. caninum serum titer of 400 (reference, !100 indicates exposure).One month later, neurologic examination was norm...