Three cases of generalized cytomegalic inclusion-body disease (salivary virus disease) in adults are reported, bringing the number of published cases up to 34. The infection is very rare in adults although well known in infants. As is often found in infants with this disease, pneumonia due to Pneumocystis carinii was also present in each case. The first patient had Wegener's granulomatosis, which presented with acute otitis media: a review of histological material obtained at mastoidectomy eight weeks before death showed that inclusion-body cytomegaly was already present then. Various antibiotics and prednisolone were given, and the lesions in the respiratory organs and the arteritis healed to a considerable extent. Renal failure, however, was progressive and led to death. The second patient had thrombotic purpura and died after a few weeks' illness, during which oxytetracycline and hydrocortisone were given. Congenital absence of the spleen was found at laparotomy, which was performed with the object of doing a splenectomy. Focal cryptococcal pneumonia was present post mortem: six years before death a solitary cryptococcal granuloma of one lung had been treated by lobectomy. The third patient had had Hodgkin's disease for 18 years. During the first 12 years the disease had the characteristics of the so-called indolent form ("Hodgkin's paragranuloma") and it then passed into the typical form. Deep x-ray therapy and cytotoxic drugs were used during the course of the disease at various times, and streptomycin and tuberculostatic drugs were given because of intercurrent tuberculous meningitis which developed three months before death. In all three cases it seems likely that the underlying disease, or the drugs used in its treatment, predisposed to cytomegalic inclusion-body disease and concomitant pneumocystis pneumonia by lowering the patients' resistance. Just as some unusual types of fungal and bacterial infections have become less rare since the introduction of certain drugs, including antibiotics and steroids, it is possible that cytomegalic inclusion-body disease and pneumocystis infection may also be met with oftener in adults, perhaps particularly as a complication of the use of these drugs in the treatment of diseases which are specially liable to interfere with the body's defences.

Adult↗

PubMed1960

Chromoblastomycosis simulating rhinosporidiosis in a patient from Ceylon.

A case of chromoblastomycosis confined to the mucous membrane of one side of the nasal septum is reported. The organism was not cultivated, but its characteristics in histological preparations were typical of those of the organisms in sections of cutaneous lesions known to be caused by Phialophora pedrosoi and related fungi. The diagnosis is considered to have been justified in spite of the great rarity of mucosal involvement in chromoblastomycosis and of the complete absence of lesions in the skin. The patient was a Sinhalese student working in London. He had first noticed the lesion before he left Ceylon, but the symptoms of nasal obstruction and bleeding were not sufficient to make him seek medical advice until two years later. If it is correct to assume that he contracted the infection in Ceylon his case is only the second on record in which there has been reason to suggest that Ceylon has been the geographical source of chromoblastomycosis. The lesion was excised and its site cauterized. There has been no sign of recurrence of the infection during the two years that have passed since the operation.

Chromoblastomycosis↗

PubMed1960