Sulfamethoxypyridazine-responsive pemphigoid nodularis: a report of two cases.

Pemphigoid nodularis is a chronic and uncommon variant of bullous pemphigoid. The condition is characterized by the presence of prurigo nodularis-like lesions, possible history of blistering, and immunohistochemical findings of bullous pemphigoid. These patients are often unresponsive to conventional therapy with potent topical and systemic steroids and different immunosuppressive agents used alone or in combination. We describe two cases of pemphigoid nodularis treated successfully with sulfamethoxypyridazine without any adverse effects.

An open clinical trial of sulphamethoxypyridazine in the treatment of mucous membrane pemphigoid.

Twenty-five patients with mucous membrane pemphigoid (MMP), whose oral lesions were unresponsive to topical steroid treatment, were treated with 1 g daily of sulphamethoxypyridazine (SMXP), a long-acting sulphonamide antibiotic, in an open prospective clinical trial. Lesion severity was assessed objectively in a semiquantitative fashion before treatment and after 14 weeks of treatment. The patient's subjective assessment of the associated pain or discomfort, using a visual analogue scale, was also recorded at these times. Three patients (12%) were withdrawn from the study owing to side-effects or complications, one due to an allergic reaction, the other two because of significant haemolysis. For the remainder there was a significant improvement in the mean objective clinical scores for desquamative gingivitis, other oral lesions, conjunctival inflammation, nasal, vulvovaginal and skin involvement, after 14 weeks treatment with SMXP (all P < 0.001, except skin P < 0. 01). Only conjunctival scarring showed no improvement. In addition, there was a significant improvement (P < 0.001) in the pain scores for the mouth, eyes, nose, vulvovaginal region and skin. The results indicate that with appropriate monitoring SMXP is an effective treatment for MMP and compares favourably with other systemic agents used in the management of this condition.

Cryptosporidium infection in beech martens (Martes foina).

Temporary episodes of diarrhea in captive beech martens (Martes foina) were accompanied by shedding of Cryptosporidium oocysts. Oocysts were detected in fecal samples by flotation and in acid-fast-stained smear preparations. The oocysts were 3-5 microns, which is consistent with C. parvum. The source of the Cryptosporidium infection remained unknown. This is the first demonstration of Cryptosporidium in beech martens.

Efficacy of sulfamethoxypyridazine in a murine model of Pneumocystis carinii pneumonia.

Sulfamethoxazole is the component of co-trimoxazole responsible for its efficacy against Pneumocystis carinii pneumonia, but this drug is associated with frequent adverse effects. Sulfamethoxypyridazine is significantly more effective than sulfamethoxazole against a murine model of P. carinii and might be a candidate for testing in infected patients.

Monodrug efficacies of sulfonamides in prophylaxis for Pneumocystis carinii pneumonia.

A remarkably high rate of adverse events is associated with the use of trimethoprim-sulfamethoxazole in patients with human immunodeficiency virus type 1 infection. We examined the efficacies of sulfonamides alone in the prevention of Pneumocystis carinii pneumonitis, with the assumption that at least some of the adverse events with the drug combination might be due to trimethoprim. With the immunosuppressed rat model, eight sulfonamides were studied at 100, 10, and 1.0 mg/kg/day (10 rats per dosage and drug). P. carinii infection was prevented in all animals (100%) receiving dosages of as little as 1.0 mg of sulfamethoxazole, sulfamethoxypyridazine, and sulfadimethoxine per kg per day, as little as 10 mg of sulfameter, sulfachlorpyridazine, and sulfaquinoxaline per kg per day; and 100 mg of sulfaguanidine and sulfanilamide per kg per day. These studies suggest that a sulfonamide, such as sulfamethoxazole, might provide effective prophylaxis for P. carinii pneumonitis without trimethoprim.

Neutrophilic dermatosis in association with rheumatoid arthritis.

Extra-articular involvement of the skin in patients with rheumatoid arthritis is not uncommon. A patient with this condition is reported who developed an unusual cutaneous eruption associated with systemic upset. Skin biopsy showed a dense dermal neutrophilic infiltrate and after treatment with standard immunosuppressive agents had failed he responded to dapsone. The rash recurred on withdrawal of the dapsone but has responded to sulphamethoxypyridamine. It is proposed that this condition is a rare but specific entity of unknown cause associated with rheumatoid arthritis.

Erythema annulare-like acantholytic dermatosis (EAAD): nonbullous pemphigus or a new entity?

This article describes a case of unusual annular erythema-like dermatosis, with histological features of pemphigus foliaceus (subcorneal acantholysis) and IgG antibodies in circulation and bound in vivo to the keratinocyte surface. The reactivity of the antibodies, restricted to human squamous epithelium, was unique, differing from that of all known forms of pemphigus. This also was confirmed by immunoprecipitation. The problem is that these circulating antibodies could be missed if not determined on human substrate. It is to be established whether such cases present a new type of pemphigus or a unknown dermatosis with an autoimmune response of a pemphigus type.

A case of relapse with drug-susceptible M. leprae after multidrug therapy.

A male born in 1930 was diagnosed as smear-positive borderline leprosy in 1971, and was treated with dapsone and/or sulfamethoxypyridazine from 1972 to 1980 with clinical improvement. However, new skin lesions with smears strongly positive appeared in August 1980, and he was diagnosed as having downgraded to lepromatous (LL) leprosy, but the bacilli recovered from the skin biopsy were fully susceptible to both dapsone and rifampin by mouse foot pad technique. Between 1981 and 1983, the patient was treated with 24 months of rifampin 600 mg and dapsone 100 mg daily, supplemented with prothionamide 500 mg daily during the initial 3 months, and his skin lesions gradually improved during treatment with the combined regimen. Afterward, the patient was kept under surveillance without treatment. From 1984 to 1986, his skin smears were negative, and no bacilli could be found from a skin biopsy taken in 1985. Then in 1987, 52 months after stopping treatment, new skin lesions appeared with a high concentration of Mycobacterium leprae (2 x 10(6)/mg tissue). The drug-susceptibility test again demonstrated that the organisms were fully susceptible to both dapsone and rifampin. Apparently the relapse was due to remultiplication of drug-susceptible persisters.

Sulphamethoxypyridazine for dermatitis herpetiformis, linear IgA disease and cicatricial pemphigoid.

One-hundred and sixty-eight cases of dermatitis herpetiformis were reviewed to compare the clinical response to and incidence of side-effects from dapsone and sulphamethoxypyridazine. Thirty-seven received sulphamethoxypyridazine (0.25-1.5 g/day) as a single agent therapy at some stage during their care and 161 had dapsone only (50-450 mg/day). Thirty of these patients received both drugs, but at different times. Both were highly effective in controlling the skin disease in 97% of patients on dapsone and 89% on sulphamethoxypyridazine. While 36 (22%) of dapsone-treated subjects had intolerable side effects warranting a change in therapy, this occurred in only five (13.5%) of those treated with sulphamethoxypyridazine. Sulphamethoxypyridazine was also effective as a single agent in three patients with linear IgA disease who had suffered adverse effects from dapsone, and in 10 out of 15 patients with oral and cutaneous lesions of cicatricial pemphigoid.

Experience with a gluten free diet in the treatment of linear IgA disease.

A study was undertaken to determine whether the skin eruption of linear IgA disease (LAD) was gluten dependent. Six patients with LAD were treated with a gluten free diet (GFD) for an average period of 33 months (range 19-48). Although one patient with LAD had an enteropathy which was clearly gluten sensitive, there was no convincing evidence that the rash of any of the patients responded to a GFD. Four of the six patients showed no significant alteration in their drug requirements. The remaining 2 patients showed a fall in minimum drug requirement but there was no increase after gluten challenge indicating that they were entering spontaneous remission. This contrasts to the situation in dermatitis herpetiformis, where both the rash and the enteropathy are gluten dependent. These data add further to the evidence that LAD and dermatitis herpetiformis are separate entities.

Elimination of the gametocytes of Theileria annulata of cattle by primaquin phosphate.

Calves were experimentally infected with Theileria annulata and five drugs were administered in an attempt to exterminate the gametocytes of the parasite. The results of the experiment proved that primaquin phosphate is an effective parasiticide. The gametocytes from 30 calves treated with primaquin phosphate were exterminated completely. A further eight calves were treated with sulfamethoxypyrazine, trimethoprim, naganin and acaprin, but these drugs were not found to be effective in eliminating the gametocytes. The phase, size and colour of the gametocytes in these calves were the same as those of the four untreated control calves.

Terapia de la paracoccidioidomicosis: valor actual de los antiguos tratamientos / Therapy of the paracoccidioidomycosis: actual value of the treatment old

Para establecer la debida perspectiva, he tratado de evocar las condiciones de la era pre-terapéutica, citando autores clásicos, que describen el resignado dolor de los pacientes y la humillada impotencia de los médicos. La época de los tratamientos antiguos fue de esperanza parcialmente frustada. Considero antiguos los tratamientos de la paracoccidioidomicosis anteriores a los imidazólicos de uso oral. Antiguos y obsoletos. De ellos nos queda el valor de la experiencia que nos permitieron adquirir. Creo que fue posible en teoría erradicar la infección de todos los pacientes mediante la administración de sulfas en dosis correctas durante dos o tres años, pero en la práctica, no se logró la suficiente claridad de criterios, ni hubo, ni hay manera de acompañar a los pacientes durante ese tiempo. Las sulfas nos enseñaron que la paracoccidioidomicosis debe tratarse ininterrumpidamente por largo tiempo. Estimo que la anfotericina permitió prolongar la vida de la mayoría de los pacientes y erradicar la infección de la mitad de los pacientes tratados correctamente. Por el alto costo y la gran atención que requiere su administración, nunca ha sido una opción liberadora en paracoccidioidomicosis. La anfotericina nos enseñó que la calidad del médico es fundamental para la conducción exitosa del tratamiento. Finalmente, en muchos países del área endémica, persiste la negligencia del estado para con la asistencia a los pacientes después de su salida del hospital, igual que en los tiempos aciagos de los tratamientos antiguos. De todos modos, considero un evento feliz el haber superado los tratamientos antiguos

Terapia de la paracoccidioidomicosis: valor actual de los antiguos tratamientos / Therapy of the paracoccidioidomycosis: actual value of the treatment old

Para establecer la debida perspectiva, he tratado de evocar las condiciones de la era pre-terapéutica, citando autores clásicos, que describen el resignado dolor de los pacientes y la humillada impotencia de los médicos. La época de los tratamientos antiguos fue de esperanza parcialmente frustada. Considero antiguos los tratamientos de la paracoccidioidomicosis anteriores a los imidazólicos de uso oral. Antiguos y obsoletos. De ellos nos queda el valor de la experiencia que nos permitieron adquirir. Creo que fue posible en teoría erradicar la infección de todos los pacientes mediante la administración de sulfas en dosis correctas durante dos o tres años, pero en la práctica, no se logró la suficiente claridad de criterios, ni hubo, ni hay manera de acompañar a los pacientes durante ese tiempo. Las sulfas nos enseñaron que la paracoccidioidomicosis debe tratarse ininterrumpidamente por largo tiempo. Estimo que la anfotericina permitió prolongar la vida de la mayoría de los pacientes y erradicar la infección de la mitad de los pacientes tratados correctamente. Por el alto costo y la gran atención que requiere su administración, nunca ha sido una opción liberadora en paracoccidioidomicosis. La anfotericina nos enseñó que la calidad del médico es fundamental para la conducción exitosa del tratamiento. Finalmente, en muchos países del área endémica, persiste la negligencia del estado para con la asistencia a los pacientes después de su salida del hospital, igual que en los tiempos aciagos de los tratamientos antiguos. De todos modos, considero un evento feliz el haber superado los tratamientos antiguos (AU)

[Surgical therapy in African mycetoma. Indications a propos of 160 cases]. / Thérapeutique chirurgicale dans les mycétomes africains. Indications á propos de 160 cas personnels.

The authors treated 160 cases of African mycetoma in Mauritania and then in Niger from september 1978 to june 1985. They here underline some guidance in the application of the utilizable surgical techniques, according to environment. The localizations met are described as well as criteria of diagnosis, pathological aspects, and responsible agents. It is important to scrutinize the extension of the lesions, and to carry out a socio-economic survey, prior to take any decision to operate. After a short commentary on the medical treatment, the authors recalled the classical surgical techniques. They explicit the criteria they selected to decide the type of intervention, along their serie. If surgery has still a preponderant position in the treatment of African mycetoma, hopes are in the discovery of a more efficient medical therapy, and the early diagnosis leading to a limited surgical therapy.