Disseminated coccidioidomycosis remained active in a 50-year-old white man six years after diagnosis of pulmonary infection and four years after diagnosis of meningitis, despite intravenous and intrathecal administration of amphotericin B. Miconazole, a new imidazole-class antifungal antimicrobic, was given by daily intravenous injection during the final 22 days of life. There was meager entry of miconazole into the cerebrospinal fluid and Coccidioides immitis was recovered in cultures of the central nervous system from material obtained at autopsy. Lesions of the lungs and peritoneum did not yield C immitis from postmortem cultures; before treatment with miconazole, cultures of sputum and a peritoneal biopsy specimen had been positive. Neither local nor systemic adverse reactions resulted from intravenous administration of miconazole. Because of safety and apparent activity, miconazole may have value in the treatment of coccidioidomycosis in patients without meningitis. (JAMA 230:1153-1157, 1974)