John H. Wehner

Rhabdomyolysis associated with 2009 influenza A(H1N1).

dations for the management of patients with herpes zoster recommend using antiviral therapy to decrease the incidence of PHN,” citing an article for which I am a coauthor. This article stated that antiviral therapy should be used to treat patients with herpes zoster and that it had an impact on acute neuritis. Although the guidelines concluded that the use of antiviral therapy may have an effect on “chronic pain,” this therapy was not sufficient to uniformly prevent PHN. As noted here, the FDA reached a similar conclusion. The goal of management of herpes zoster is to accelerate healing, prevent complications, and decrease pain—both acute pain and PHN. With the evidence available from existing antiviral studies, these end points have been achieved with the exception of prevention of PHN. The management of PHN is of critical importance for individuals who have herpes zoster. Consideration of combination therapy at the onset of disease, particularly in patients with severe acute pain, needs to be further evaluated. Future treatment strategies may prevent or provide more significant relief for this potentially devastating complication.

Airway Coccidioidomycosis-Report of Cases and Review

Infection due to Coccidioides immitis usually begins in the lungs. Despite the initial pulmonary portal of entry, endotracheal and endobronchial coccidioidomycosis has rarely been described. Since the introduction of fiberoptic bronchoscopy and the AIDS epidemic, more C. immitis lesions of the large airways have been noted. We present data on 38 cases of coccidioidomycosis of the airways, including 6 cases detailed from our own experience and 32 from the literature. Direct infection of the airways (28 cases) is a more common mechanism of airways disease than is erosion into the airways from a lymph node (5 cases). Bronchoscopic findings vary and may show mucosal involvement or intrinsic obstruction. Endotracheal and endobronchial disease is not a self-limited disease and requires antifungal therapy. Disseminated disease in these patients is common. Coccidioidomycosis must be considered in the differential diagnosis of airway pathology.