Fatal Disseminated Coccidioidomycosis in Cirrhosis: A Case Series.

PURPOSE: Coccidioidomycosis is endemic to the Southwest United States and Mexico. In this case series we describe 3 cases, occurring in the Southwest United States, of patients with disseminated coccidioidomycosis infection in cirrhosis, all with a miliary pattern present on chest imaging. METHODS: This case series was performed conducting a review of patients' electronic health records and thorough review of the literature for coccidioidomycosis infection in patients with liver disease. RESULTS: Three patients with different etiology of liver disease with Model for End-stage Liver Disease - Sodium (MELD-Na) scores >20 had chest imaging findings indicative of a miliary pattern on presentation. Each patient subsequently had extensive infectious disease workup that showed evidence of disseminated coccidioidomycosis. All 3 patients clinically worsened and eventually died. CONCLUSIONS: This case series highlights the severity of disseminated coccidioidomycosis in patients with cirrhosis in an endemic area, as well as potential early clues such as miliary patterns on chest imaging. A review of the literature found a significant connection among potential mechanisms describing why patients with cirrhosis have such adverse outcomes in the setting of disseminated coccidioidomycosis, including cirrhosis-associated immune dysfunction and genetic defects in immune functioning.

Comparison of clinical and radiological outcomes in intertrochanteric fractures treated with InterTAN nail against conventional cephalomedullary nails: a systematic review.

Intertrochanteric fractures, accountable for 50% of hip fractures, can be fixed with cephalomedullary devices such as Proximal Femoral Nail Antirotation (PFNA™), Gamma3 nailing system and TRIGEN™ InterTAN™ nail (IT). IT uniquely uses two cephalocervical screws that allow for linear compression and provide additional resistance to femoral head rotation. A literature review assessing clinical outcomes of these devices was conducted, with 14 studies enrolling 3104 patients meeting the inclusion criteria. PFNA and Gamma3 had better intraoperative outcomes compared with IT; however, IT had superior implant-related outcomes of cut-out and screw migration. No difference was found between IT and PFNA or Gamma3 in Harris Hip Scores, time to union, malunion and nonunion. Further long-term studies are needed to evaluate clinical outcomes and cost-effectiveness of cephalomedullary devices.