Cerebral vasculitis in coccidioidal meningitis

Cerebral vasculitis producing focal central nervous system manifestations was observed in 2 patients with meningitis due to Coccidioides immitis . Cerebral angiography demonstrated the characteristic changes of arteritis, including irregular narrowing of arteries at the base of the brain in 1 patient and occlusion of a middle cerebral artery branch in the other. Pathological examination of the brain in the latter patient revealed extensive basilar meningitis along with prominent vasculitis and organisms. One patient responENd to intrathecal and intravenous amphotericin B treatment combined with a ventriculopleural shunt, the other died despite amphotericin B therapy.