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A case is described in which Hodgkin's disease was complicated by inclusion disease and gastrointestinal moniliasis. This is one of several cases of malignant disease complicated by uncommon infections.
Most previous reports of esophageal moniliasis have described diffuse changes in the esophagus. The authors describe two cases involving a localized polypoid lesion in the esophagus in patients with Candida infection. The pathogenesis is discussed.
A case of persistent oesophageal stricture due to moniliasis, which developed while the patient was symptomatic, is reported. The value and therapeutic implications of performing a repeat barium swallow even if the disease appears to be quiescent are discussed.
Two pediatric cases are described presenting a conjunction of Addison's disease and hypoparathyroidism. One of the two cases also exhibits moniliasis of the oral cavity (Whitaker's disease). A full report is given of the symptoms and of the laboratory analyses which have motivated the diagnosis, and of the endocrinological function tests which were intended to confirm the diagnosis. The clinical process and the therapeutic criteria adopted are subsequently reported. A discussion follows focusing on the possible causes of the coexistence of the immunological defect and of the endocrinous deficiencies which are typical of the syndrome. Pathogenetic priority is attributed to the immunological defect which induces a autoimmune lesion of the endocrinous glands concerned.
Esophageal moniliasis is found rarely. It has been described mainly in chronically ill patients, who receive antibiotics and corticoesteroids. Early diagnosis and treatment betters their prognosis. Nine patients, 5 males and 4 females were studies in Hospital General del Centro Medico Nacional in Mexico City. Their agesranged from 26 to 77 years, with a mean of 49 years. All patients were chronically ill and 7 of them were treated in the intensive care unit. Three had disphagia, 3 retrosternal pain, and 2 gastrointestinal hemorrhage. Eight patients had high W.B.C., 3 irregular filling defects on X ray studies, and on endoscopy, all showed a pseudomembranous white yellowish exudate, underneath it the mucosa was inflamed, irregular and bled scantily. In 5 out of 9 patients biopsy and a smear confirmed the diagnosis. Eight patients treated with nystatin were cured. This disorder must be suspected in patients with disphagia and retrosternal pain; esophagoscopy is the prefered procedure to establish this diagnosis.
The efficacy and tolerance of mepartricin sodium lauryl sulphate (SPA-S-222) was evaluated in patients with vaginal trichomoniasis and/or moniliasis. One group received 4 tablets/day for 3 days (group "A"), and the other (group "B") 1 tablet/8 hr for 4 days. A lasting microbiological cure was obtained in all cases. Tolerance was better in group "B" and it is felt that this protocol should be preferred.
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