796 EDGAR ROSEN AND JOSEPH P. BELBER COCCIDIOIDAL MENINGITIS OF LONG DURATION: REPORT OF A CASE OF FOUR YEARS AND EIGHT MONTHS' DURATION, WITH NECROPSY FINDINGS *

ALTHOUGH a sufficient number of cases of coccidioidal meningitis has now been published in the medical literature to merit consideration of this disease in all patients with obscure meningitides, the diagnosis can be readily overlooked unless it is kept in mind. The patient reported in this paper was not correctly diagnosed until his final hospital admission and his fifth year of illness, although he had been studied extensively in four other hospitals at various times since the start of his illness. Our main purposes in reporting this patient are to review the problems in diagnosis which he presented, and to stress the pertinent data which could have led to an accurate clinical appraisal early in the course of his disease. The lengthy duration of this patient's illness is also a matter of considerable interest, since we were unable to find any published reports of cases surviving nearly this long. However, we have been informed by Dr. Charles E. Smith15 of three unpublished cases with a duration of approximately four years each. Although the endemic areas for coccidioidomycosis are limited in this country to certain regions of the West and Southwest,14 widespread interest in the disease has been awakened in recent years. As a result of increased military and civilian travel, coccidioidal infections have been observed in areas far removed from endemic regions. An initial infection acquired in an endemic area may not pro