Juxtapapillary choroiditis associated with chronic meningitis due to Coccidioides immitis

A 73-year-old man had chronic meningitis of uncertain origin. Ophthalmologic examination revealed juxtapapillary choroiditis with an associated localized serous retinal detachment. Subsequent laboratory evaluation demonstrated absent serum complement-fixing antibody titers to Coccidioides immitis, but serological examination of the CSF demonstrated an antibody titer of 1:2. The final diagnostic impression was that of chronic meningitis in association with juxtapapillary choroiditis due to C immitis.