A 35-year-old man with known coccidioidal meningitis developed a severe headache and vomiting during routine treatment. Hydrocephalus was visible on brain imaging, and CSF study revealed pleocytosis, lowering of glucose, and increased intracranial pres sure. Dexamethasone and mannitol was used for intracranial pressure control. In trathecal amphotericin B administration and switching to itraconazole