A 63-year-old man was admitted on January 5, 1981, complaining of headache, cough and a lowgrade fever. Neurological examination revealed neck stiffness and papilloedema. Chest X rays showed infiltrative shadows with a large irregular cavity in the right upper lung. Lumbar pressure disclosed an opening pressure of 320 mmH₂O. The CSF and sputum smears revealed numerous cryptococci. A CT-scan of the brain showed a low-density area in the left basal ganglion. He was diagnosed as having pulmonary cryptococcosis and cryptococcal meningitis with cerebral cryptococ coma. He was treated intravenously with amphotericin B and orally with flucytosine for 2 months. This combined therapy partially improved the cough, headache and CSF findings, but side effects caused by the amphotericin B's toxicity appeared, i.e., polyuria, hypokalemia, a fall in creatinine clearance, anorexia, anemia and general malaise. Because of these problems with the amphotericin B therapy, the miconazole therapy was begun at 200mg intravenously every 6 hours and 20mg intrathecally every 3 days. In order to inject miconazole into the ventricle an Ommaya reservoir was inserted into the anterior horn of the right temporal ventricle on April 9, 1981. The miconazole therapy was continued intravenously (1200mg per day) and intraventricularly (10mg per day). He tolerated the miconazole therapy well, with no side effects, and gradually the cough, sputum and headache were improved. After 8 months, the CSF pressure returned to the normal level and the infiltrative shadows in the chest radiograph disappeared. Miconazole thus proved to be an effective and only weakly toxic drug in the treatment of cryptococcal meningitis.