Disseminated coccidioidomycosis in a patient who is immunocompromised in the setting of immune reconstitution inflammatory syndrome.

Coccidioidomycosis is a systemic fungal infection first described in 1892. More than 95% of annual cases occur in Arizona and California. It is an opportunistic infection (OI) transmitted via inhalation of airborne spores (arthroconidia) and rarely via percutaneous inoculation into a tissue or solid organ transplantation in patients who are immunocompromised and with HIV. With the advent of antiretroviral therapy (ART), the incidence of OIs has markedly reduced; however, OIs continue to occur, particularly in patients who present late for medical care or delay ART initiation. In rare cases, immunodeficient individuals may experience a paradoxical worsening or unmasking of OI symptoms, known as the immune reconstitution inflammatory syndrome (IRIS). We present a case of a 31-year-old man with disseminated coccidioidomycosis affecting the spleen, lymph nodes, lungs, bone marrow, and adrenals who developed IRIS after the initiation of ART.

The Rash, the Weakness, and the Nephritis: Nerve and Kidney Biopsy Findings in Eosinophilic Granulomatosis With Polyangiitis.

We present a case of eosinophilic granulomatosis with polyangiitis (EGPA) or Churg-Strauss syndrome in a 66-year Caucasian female who presented with a severe pruritic itch and a progressive upper and lower extremity weakness of unknown duration. The diagnosis of EGPA in this patient remained elusive for an extended period of time due to the absence of respiratory symptoms. In this article, we also discuss the histologic features of EGPA seen in biopsies of the kidney and the nerves and highlight the value they play in diagnosis.

Effect of lung cancer screening awareness on smoking cessation behavior.

BACKGROUND AND OBJECTIVES: Emphasizing the risk of lung cancer can encourage smoking cessation; however, computerized tomography (CT) scans reduced lung cancer mortality in a recent randomized screening trial. We postulated that awareness of lung cancer screening test will negatively impact smoking cessation behavior. METHODS: We identified 7,141 respondents who answered questions concerning their smoking-related behavior in the 2007 Health Information National Trends Survey (HINTS). We used survey weights in all analyses and used logistic regression models to assess the association of smoking status with awareness of lung cancer screening tests and evaluated smoking cessation behaviors. RESULTS: Overall, 2,183 (27.6%) of respondents had heard of a lung cancer screening test (26.9% among never smokers, 29.6% among former smokers, and 27.1% among current smokers). Smoking status was not associated with awareness of lung cancer screening tests. Among current smokers, awareness of lung cancer screening had no effect on quit attempts in the previous 12 months (OR=1.14, 95% CI=0.68-1.91) and consideration to quit in the next 6 months (OR=1.08; 95% CI=0.69-1.67). CONCLUSIONS: Smoking cessation should be recommended for all current smokers, and those with a history of smoking should be informed about lung cancer screening with CT scan.