Cryptococcal Infection Treated with 2-Hydroxystilbamidine in a Patient with Boeck's Sarcoid

Abstract

in the literature as individual reports. The disease does not appear to be endemic, having a generalized distribution throughout the world. The majority of cases in the literature have been of the meningeal form ; however, a few reports have presented only pulmonary, cutaneous, or osseous involvement. A variety of therapeutic agents have been employed with generally disappointing results. Evaluation of therapy has been made difficult because of scattered, individual case reports as well as spontaneous remissions seen in this disease. We therefore urge the report of all such cases and present one of our own. In presenting this case we have two considerations ; therapy with 2-hydroxystilbamidine and the significance of a coexisting granulomatous process.

Sarcoidosis in Identical Twins

“…The organism was resistant in vitro to p-aminosalicylic acid, streptomycin, and penicillin, of each of which the patient had received full courses before the cryptococcal infection was recognized; it was sensitive in vitro to 2-hydroxystilbamidine, but clinical manifestations of the bone infection had already subsided before this drug was first given, and neither it nor nystatin had any effect on the meningitis. The ineffectiveness of treatment conforms with the published experience of others (see Littman and Zimmerman, 1956), although Leithold et al (1957) have suggested that 2-hydroxystilbamidine was responsible for the "apparent cure'" (15{ months' observation without evidence of recurrence) of the cryptococcal infection in their patient with sarcoidosis. This is the nineteenth case of torulosis in this country.…”

“…The natural environment of C. neoformans is not known; pathogenic strains have been isolated from soil (Emmons, 1951) and from pigeon nests and droppings (Emmons, 1955). Spontaneous infections occur in animals, but seem to be uncommon (literature: Skulski and Symmers, 1954); the only animal infection so far reported in Britain was in a pet ferret (Skulski and Symmers, 1954), although Carter and Young (1950) Fisher (1950, Case 2), a case described by Gandy (1950), two cases illustrated by Littman and Zimmerman (1956), a case described by Lepow et al (1957), that reported by Leithold et al (1957), and a further case which Littman and Zimmerman (1956) mentioned and which they said would be reported by Heller, McLean, Campbell, and Jones (1957). Torulosis has repeatedly been observed in cases of Hodgkin's disease and other malignant diseases arising in the lymphoreticular system; Zimmerman and Rappaport (1954) reviewed this association, and from their study of the cases filed in the Armed Forces Institute of Pathology at Washington D.C. presented evidence which strongly supports the belief that the mycotic infection in such cases is a complication of the primary disease of the lymphoreticular system and not its cause.…”

Sarcoidosis

“…Leithold et al (1957) reported the case of a black man, aged 27, in whom sarcoidosis, manifested by mottling in the ehest radiograph and superficial lyrnphadenopathy with typical biopsy changes, was complicated rwo years from the onset by an absces s below the right scapula, proved by culture to be cryptococcal, and treated successfully by 2-hydroxystilbamidine. Later, an enla rged spleen was removed, and showed sarcoid changes, cryptococcus not being demonstrable.…”

Smith's Fracture and Anterior Marginal Fracture of Radius

“…Fisher (1950, Case 2), a case described by Gandy (1950), two cases illustrated by Littman and Zimmerman (1956), a case described by Lepow et al (1957), that reported by Leithold et al (1957), and a further case which Littman and Zimmerman (1956) mentioned and which they said would be reported by Heller, McLean, Campbell, and Jones (1957). Torulosis has repeatedly been observed in cases of Hodgkin's disease and other malignant diseases arising in the lymphoreticular system; Zimmerman and Rappaport (1954) reviewed this association, and from their study of the cases filed in the Armed Forces Institute of Pathology at Washington D.C. presented evidence which strongly supports the belief that the mycotic infection in such cases is a complication of the primary disease of the lymphoreticular system and not its cause.…”