Multiple Invasive Squamous Cell Carcinomas and Common Variable Immunodeficiency

Abstract

800 mg/d) in divided doses. Clinical improvement was assessed at monthly intervals, and liver function tests were repeated.Significant improvement was noticed after 2 months of therapy. The improvement consisted of a decrease in infiltration and size of the nodules. On completion of 3 months' therapy, one patient showed moderately elevated levels of serum aspartate transaminase (72 U/L) and serum alanine transaminase (48 U/L). Clinically, he appeared normal, and the other laboratory tests revealed no abnormality. The dose of ketoconazole was continued, hoping that the liver function would not deteriorate further. When this patient neared 4 months' therapy, the serum aspartate transaminase level rose (100 U/L), the serum alanine transaminase level rose (120 U/L), and, clinically, gynecomastia was noted. Therapy was stopped, and we continued observation of this patient. The second case showed satisfactory improvement after 4 months, and, at 6 months, the papules had regressed well. Ketoconazole had to be given for a total of 9 months before the patient could be declared both clinically and histopathologically cured. The third patient showed similar improvement but, unfortunately, gynecomastia developed toward the end of 8 months of therapy. Laboratory tests showed an increase in the serum alanine transaminase level to 72U/L; serum aspartate transaminase levels were normal. Ketoconazole therapy was discontinued, and we contin¬ ued observing the patient. The condition of the fourth patient im¬ proved, but he dropped out after 4 months of treatment. Ketocona¬ zole toxicity has developed in two patients; gynecomastia has almost subsided in one patient and in another it is regressing. The abnormal enzyme levels are also decreasing. We intend to administer sodium antimony gluconate after their condition is completely restored to normal. The hypopigmented macules showed no significant change in any of the patients.Comment. -Ketoconazole (400 mg/d) has been successfully used to treat cutaneous leishmaniasis when given for a period of 3 months.3 It has also been given for a relatively shorter duration of 4 weeks,4 the difference in the length of treatment being attributed to the species of parasite prevalent in a region and the host response. In visceral leishmaniasis, keto¬ conazole (600 mg/d) was given for 4 weeks to bring about a cure.2 None ofthese patients experienced serious side effects sufficient to warrant stoppage of therapy. In a previous study (unpublished) we tried ketoconazole (400 mg/d) in two pa¬ tients with PKDL for almost 3 months without any signs of the disease subsiding. This made us increase the dose to 800 mg/d in the present study. Only one person was complete¬ ly cured after 9 months of therapy. Gynecomastia and raised aminotransferase levels developed in two patients, one of them having almost reached the end of therapy.In fungal infections where ketoconazole has been used for prolonged periods in doses ranging from 200 to 400 mg/d, it has generally been well tolerated, the incidence of gyneco¬ mas...