Ian writes:
"She had been seen elsewhere for treatment of her "severe psoriasis" which she had for the last two years. Clinically this is chronic mucocutaneous candidiasis. There is no family history. She has had vaginal candidiasis before and UTIs. She is otherwise well. She did have shotty glands in neck, groin and axillae.
Has anyone had recent experience of treating a case? Ketoconazole orally ? toxicity? Fluconazole orally? How long for? Best wishes, Ian."
Thank you Ian for sharing this extra ordinary case of mucocutaneous candidiasis with us. Oral fluconazole has a better safety profile than oral ketoconazole in such cases.
ReplyDeleteGood luck, Dr. McColl with this challenging case. It would be greatly appreciated to see follow-up photos after you have "cured" this young girl. She is lucky to have stumbled on your practice.
ReplyDeleteBest wishes, AR Pito, Norfolk.
The clinical picture is in favor of psoriasis rather than mucocutaneous candidiasis.The presence of candida albicans is a secondary invader of the nails and angles of the mouth.
ReplyDeletekhalifa Sharquie, Baghdad
Here are some comments from Anne Junker, a pediatric immunologist at U of British Columbia.
ReplyDelete"Poor kid! We saw a few kids in earlier days, before CMC went by the board as a "distinct" syndrome. Treatment is obviously antifungals, long term; often relapsing disease or development of antimicrobial resistance. We had one child who "grew out of" this -- lots of problems as an infant and toddler, which resolved by school age. There seems to be a view that CMC is associated with a variety of immune defects, rather than a distinct syndrome with unique abnormality in immune function. The largest association is CMC with autoimmune polyendocrinopathy type 1, due to mutations in the AIRE (autoimmune regulator) gene. These patients may have normal T cell function, but problems dealing with candida due to defective antigen presentation and downstream responses. There is also association with thymoma, but this is pretty rare in little kids."
Would like to know if she has Iron deficiency.Addition of Iron to C. Fluconazole would probably help.
ReplyDeleteAny further new news about this case
ReplyDeletekhalifa sharquie
Cultures of her mouth, scalp and nails all grew candida. She is iron deficient. She has no evidence of any endocrine disease at this stage. She has been started on Fluconazole 100mgs a day. She weighs 16 kilos and the dose may have to be increased. I will organise for some iron supplement as well and send some images of her scalp when she is next reviewed.
ReplyDelete