Advances in Large Volume Subcutaneous Injections: A Pilot Tolerability Study of an Innovative Needle-Free Injection Platform.

Many medical conditions require chronic treatment with subcutaneous injectable biologics often exceeding 1.0 mL. However, subcutaneous administration of volumes of 2.0 mL or greater using a standard needle and syringe or auto-injector proves challenging, and patients often must administer two separate injections to achieve their full dose or endure injection times in excess of 10 s if using a mechanical autoinjector. In addition, needle-based injections often cause patient anxiety and discomfort. In this article, we describe an approach to meet these needs with a needle-free medication delivery device capable of rapidly delivering up to 2.0 mL with minimal discomfort. A pilot study was conducted with this needle-free injection system to evaluate the delivery of a 2.0 mL volume in human subjects. The results demonstrated that injections of up to 2.0 mL were well tolerated and often preferred over two separate 1.0 mL injections using the needle-free injection system.

Radiological reasoning: miliary disease, vertebral osteomyelitis, and soft-tissue abscesses.

OBJECTIVE: We present a case of disseminated coccidioidomycosis with miliary disease and extrathoracic spread to the breast, the retroperitoneum, the soft tissues of the neck, and multiple vertebrae with spinal cord compression. We discuss the differential diagnosis of the imaging presentation, as well as the specific clinical and imaging features of coccidioidomycosis. CONCLUSION: Disseminated coccidioidomycosis in a nonendemic area can be difficult to diagnose, even with an excellent clinical history, as almost every organ system can be involved. Widespread disease can be seen and spinal involvement can easily be mistaken for malignancy, Pott's disease, or other granulomatous disease. Miliary disease with concomitant breast involvement is a rare presentation of disseminated disease. Detection of specific radiographic patterns of involvement and recognition of travel to or from an endemic area can lead to an accurate diagnosis and earlier treatment.