Chronic muco-cutaneous candidiasis of late onset, thymoma and myopathy

A patient with late onset chronic muco-cutaneous candidiasis, a thymoma and myasthenia gravis is described. Brief reports are added of three other patients with closely similar syndromes. Immunological studies and electron microscopic findings are recorded and discussed. The presence of a thymoma should always be suspected in patients with chronic mucocutaneous candidiasis of late onset.     

Studies on the phagocytic activity of the granulocytes in psoriasis and palmoplantar pustulosis

A kinetic method was used to determine the rates of phagocytosis of IgG-coated and C3b-IgG-coated latex particles by neutrophil granulocytes from twenty patients with psoriasis and twenty with palmoplantar pustulosis (PPP). Patients with psoriasis showed a highly increased rate of uptake of IgG-coated particles. An increased rate was also observed in patients with PPP. These results indicate enhanced Fc-receptor function. In healthy controls the uptake rate of C3b-IgG-coated particles was at least 30% higher than that of particles coated with IgG alone. In nearly half of the patients in the psoriasis and PPP groups the uptake rate failed to increase in the normal way, indicating that C3b dysfunction is common in both psoriasis and PPP. In neither group was there any relationship between the rate of phagocytosis and the clinical severity of the disease.     

Measurement of 59Fe absorption and retention in patients with familial chronic muco-cutaneous candidiasis using the method of whole body counting

A study of ⁵⁹Fe absorption was carried out on fourteen patients with familial chronic muco-cutaneous candidiasis (FCMC) using the method of whole body counting. ⁵⁹Fe retention was also determined in eleven of these individuals, for periods up to 133 days. Eight of fourteen patients absorbed less than 6% of the ⁵⁹Fe administered. Six of these subjects had previously shown evidence of impaired iron tolerance in the presence of latent iron deficiency. Iron excretion was not increased in any of the individuals studied. These observations support the view that iron absorption may be impaired in some patients with FCMC and could be a contributory factor in the aetiology of the latent iron deficiency associated with the condition.     

Proximal subungual candida onychomycosis. An unusual manifestation of chronic muco-cutaneous candidosis

Instead of presenting the classical appearance of granulomatous dystrophic nails due to Candida , a patient with chronic mucocutaneous candidosis showed, at each recurrence, transverse cloudy leuconychia which appeared beneath the normal cuticle of several fingernails. This pattern of infection was that of proximal subungual onychomycosis. This has been demonstrated histologically and the observation widens the range of organisms known to cause this type of fungal infection.     

Autoimmune polyendocrinopathy and chronic mucocutaneous candidiasis

The authors report the case of a child who, at the age of 18 months showed signs of hypoparathyroidism together with gastrointestinal, then buccal, then ungual candidiasis. Acute adrenal failure occurred when he was 5 1/2 years' old. At the age of 10, the patient developed alopecia areata and interstitial keratitis. Immunological investigations yielded normal results, except that serum was weakly positive for anti-adrenal antibodies at 1/10th. The mucosal and ungual candidiasis infection was cured by ketoconazole, and the various endocrine abnormalities were corrected with the appropriate replacement therapies. This case prompted the authors to review the candidiasis/"polyglandular autoimmune disease" association. Whitaker's triad consists of candidiasis, hypoparathyroidism and chronic renal failure, 2 or these 3 elements being sufficient to make the diagnosis. Numerous other associations have been described; they are presented here in table form in descending order of frequency, with candidiasis/hypoparathyroidism coming on top of the list (70 p. 100). The fairly constant chronological order in which these different pathologies appear is one of the peculiarities of the syndrome: candidiasis often precedes hypoparathyroidism and adrenal insufficiency. Alopecia areata does not seem to be frequent, but its true incidence is difficult to quantify since lesions of the scalp and/or skin appendages are poorly documented in the literature. Alopecia and keratopathy seem to be of autoimmune origin. Mucocutaneous candidiasis too is specific, the mucosae and nails being constantly involved. This type of candidiasis does not exist in other forms of hypoparathyroidism. Chronic mucocutaneous candidiasis is found in many different diseases and is due to immunodeficiency against Candida spp.(ABSTRACT TRUNCATED AT 250 WORDS)     

The effect of nizoral and tinidazole on neutrophilic phagocytic activity in patients with rubromycosis and candidiasis

Nisoral and tinidasole effects on Trichophyton rubrum and Candida albicans ability to be destroyed by neutrophils were under study, as were the characteristics of neutrophil phagocytic activity in patients with various forms of trichophytosis and candidiasis over the course of nisoral or tinidasole therapy or combined therapy with both the drugs. Tinidasole and more so nisoral were found to enhance neutrophilic fungicidal activity towards Tr. rubrum and C. albicans. Combined therapy with nisoral and tinidasole distinctly augmented the counts of Ns-RFC and Nc-RFC and increased the values of the phagocytic index and the phagocytic number. Combined administration of the drugs was conducive to elevation of the neutrophilic ability to destroy the fundal elements.     

Deficient neutrophil function in a patient with chronic mucocutaneous candidiasis, thymoma and myasthenia gravis.

The case of a 68-year-old man who suffered the onset of chronic mucocutaneous candidiasis, thymoma, myasthenia gravis and a reversible neutrophil dysfunction during adult life is reported. All tests for humoral and cellular immunity proved normal. Thymectomy and the administration of transfer factor had no effect on the skin disease. Long-term oral administration of 5-fluorocytosine almost cleared the skin lesions; the neutrophil defect disappeared.     

Azathioprine in the treatment of muco-cutaneous pemphigoid

Four patients with muco-cutaneous pemphigoid were treated with azathioprine. Satisfactory control of the cutaneous lesions was maintained in two patients, in one of them with concomitant use of a corticesteroid. Oral ulceration was less frequent in three patients, and in two patients with ocular involvement visual impairment did not progress. Although the various complications of azathioprine therapy need to be considered, this drug may significantly improve the prognosis regarding vision in patients with ocular changes otherwise totally unresponsive to therapy.