A male patient 68 years, suffering from pyoderma gangrenosum which was resistant to conventional treatment, received clofazimine 400 mg daily for 5 months, then reducing to 300 mg daily for the next 6 months. Eleven months after starting the drug, he was admitted to hospital with severe abdominal pain, laparotomy revealing infarction of the spleen, with violaceous congestion of the small bowel. The spleen was removed and post-operative recovery was satisfactory. Histopathological examination of the spleen (removed at operation) and of tissue from a duodenal biopsy (taken postoperatively) showed large numbers of striations and outlines suggestive of crystal deposition. Mesenteric lymph node revealed a massive accumulation of crystals in cortical and medullary sinuses. The findings emphasize that clofazamine should not be used in high dosage over prolonged periods of time, except under close clinical and laboratory supervision, and for conditions not amenable to other drugs.
ALTHO uc H our bacteriological and pathological studies on the nose in patients with leproniatous leprosy (Davey and Rees, 1974; McDougall et aZ., 1975) underline the importance of nasal secretions as a major source of Mycobacterium Zeprae in the transmission of leprosy, they do not necessarily clarify the route of infection. However, patients whose nasal mucus is loaded with M. Zeprue might be expected to produce and to project infected aerosols and droplets during talking, coughing and sneezing. Similarly, M. Zepraeinfected particles from shed and dried nasal secretions in handkerchiefs or on the ground could become airborne. A comparison of the modes of spread and incidence of pulmonary tuberculosis and leprosy (Rees and Meade, 1974) in comparable populations in South India has indicated that the attack rates for the two diseases in family or household contacts are similar, as are also the numbers of M. tuberculosis excreted in sputum and of M. Zeprae excreted in nasal discharges by patients with pulmonary tuberculosis and lepromatous leprosy respectively (Rees and Meade, 1974). Thus it was reasonable to consider a respiratory route of infection for leprosy, and the present study was undertaken to determine whether mice were susceptible to airborne infection with M. leprae.
MATERIALS AND METHODSThe present larger scale experiment was based on results obtained in 1967 when one of us (R. J. W. R.) was investigating the different routes for infecting mice with M. leprae. By airborne infection the only three mice successfully infected were killed 15-23 months after exposure to M. leprae; unfortunately the 17 other mice exposed to infection had been killed earlier and all were negative, Therefore in the present study the outcome of airborne infection was confined to mice killed 14 months or more after exposure to M. leprae.Methods for production of and exposure to airborne infection The apparatus used was based on that described by Henderson (1952) and Druett and May (1952), modified for 10 mice at a time to be exposed to clouds of dry bacteria-containing particles of 1-2 p m diameter. In this apparatus, only the head of the mouse is exposed to the infective cloud.The physical conditions of the apparatus for the delivery of clouds containing M. leprae were adjusted to those that had been established for the quantitative delivery of known numbers of viable particles of M. tuberculosis reaching the lungs of mice (S. Peacock, personal communication). It was estimated that the lung retention per mouse was 7 ml of the bacteria-containing cloud per min. and that from a reservoir containing 5 x 106 viable units of M. tuberculosis per ml, a cloud of 1 x 104 viable units per litre per min. was produced. Therefore the average rate of lung challenge with M. tuberculosis per mouse was 70 viable
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.