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921 IMPROVED LYMPHOCYTE STIMULATION AFTER KETOCONAZOLE TREATMENT FOR CHRONIC MUCOCUTANEOUS CANDIDIASIS (CMC)

The role of infection in the immunodeficiencies of CMC was investigated by monitoring immune function during treatment with the new antimycotic ketoconazole. Cellular and humoral immunity was evaluated before, during, and after 6 months of therapy in 5 patients (age 3-9 yrs). Prior to therapy, 5 patients had diminished lymphocyte stimulation to antigen, 4 had serum inhibitors of lymphocyte stimulation, 2 had low IgA class antibodies to candida and other antigens, and 1 was IgA deficient.All responded to treatment with rapid clearing of mucosal and skin lesions. There were no consistent changes in serum immunoglobulins or class specific antibodies to candida or E.coli O antigens or in blood lymphocyte subpopulations. However, mitogen response increased (x=1.8 fold pre-treatment) and serum inhibition of this response decreased during treatment. Stimulation indices increased in cultures with candida (x=11 fold) and SK-SD (x=6.2 fold) but the patient's sera continued to inhibit these responses. When treatment was discontinued in 3 patients during or after 6 months of therapy, candidal stomatitis recurred.Since treatment of CMC patients with ketoconazole improved the responsiveness of lymphocytes to antigenic stimulation without removing the serum inhibitory capacity, these 2 mechanisms may be dissociated. Infection-independent and infection-dependent mechanisms appear to be involved; however, a direct role of ketoconazole on the immune system cannot be excluded.