Successful treatment of cerebral cryptococcoma and meningitis with miconazole.

Cryptococcal meningitis and a cerebral cryptococcoma developed in a patient with pulmonary cryptococcosis ("coin lesion") shortly after infected area of lung was removed. Treatment with amphotericin B and flucytosine failed to clear the organisms and antigen from the spinal fluid or alter the neurologic manifestations related to the cerebral lesion. Therapy with miconazole cured the meningitis and led to disappearance of the lesion in the brain (serial computed tomographic scan). Study of the patient over the next 5 years disclosed no evidence of relapse of infection and completely normal findings on neurologic examination.