regression of kaposi's sarcoma in aids after treatment with dapsone

560

Meat consumption by amenorrhoeic and regular runners.

Weekly total meat consumption was different: regular = 688±150 g,amenorrhoeic= = 150±47g,p<0-05.Sowaawhitemeat(pouhry)consumption(296±92 vs 66±21 g; p<0-05) and red meat consumption (392±I11 g vs85±41 g; p<0- 05). Both groups ate the same amount offish: regular 152±59 g,amenorrhoeic = 179±60 g; p>0-75.

dietary difference was in fat consumption (regularly menstruatingrunners ate 98±11 SEM g/day, amenorrhoeic runners ate 68±8

g/day; p<0 05, paired t test). In other dietary respects, the dailyintakes of the groups were similar (calories 2135±144 kcal,carbohydrate 263±19 g, fibre 5’7±0’4 g). Even though meatconsumption was different, that of total animal protein was similar(44±5 g/day); the amenorrhoeic group took more dairy products.The two groups were similar in respect of age (28 - 2-t . 0), age atmenarche (13-6±0-3), weekly training (65-2±3-4 4 km), and bodyfat as determined by hydrostatic weighing (17 - 2±0 - 9).A high frequency of vegetarianism in the amenorrhoeic group was

unexpected. We cannot be certain that athletic amenorrhoea iscaused by a vegetarian diet. There are however, hormonal

precursors9,10 and essential minerals such as zinc and iron thatcould be adversely affected by reduced intake of meat, especially inactive people. On the other hand, infertility routinely occurs ingrazing animals that consume plants rich in phyto-oestrogens.11Since many plants have such properties 12 the amenorrhoeic runnersmay be consuming some naturally occurring birth controlsubstance. However, we know of no scientific evidence of an

T

association between vegetarianism and secondary amenorrhoea,although the vegetarian community is replete with anecdotes ofsuch a relationship.We thank Elaine Cress, Jackie Bermng, Kim Gollick, David Welsh, and

Dr K. Horwitz.

Supported by National Institutes of Health grant HD 15617.

Human Performance Laboratory,University of Colorado,Boulder, Colorado 80309, USA,and Cardiovascular Pulmonary ResearchLaboratory,

Departments of Medicineand Obstetrics and Gynecology,

University of Colorado Health Sciences Center,Denver, Colorado

SUSAN M. BROOKSCHARLOTTE F. SANBORNBRUCE H. ALBRECHTWILTZ W. WAGNER, JR

9 Hill PB, Wynder EI., Effect of a vegetarian diet and dexamethasone on plasmaprolactin, testosterone, and dehydroepiandrosterone in men and women. CancerLetters 1979, 7: 273-82.

10. Goldin BR, et al. Estrogen excretion patterns and plasmal levels in vegetarian andomnivorous women N Engl J Med 1982, 307: 1542-47

11. Braden AWH, Hart NK, Lamberton JA. Disorders of grazing animals due to plantconstituents In Moore RM, ed Australian grasslands Canberra, 1970 381

12 Farnsworth NR, Bingel AS, Cordell GA, Crane FA, Forng HHS Potential value of

plants as sources of new antifertility agents. J Pharm Sci 1975; 64: 535-98, 717-54

REGRESSION OF KAPOSI’S SARCOMA IN AIDSAFTER TREATMENT WITH DAPSONE

SiR,-Radiotherapy and cytostatic agents are recommendedtreatments for- Kaposi’s sarcoma. Successful treatment with

dapsone of a case of Kaposi’s sarcoma-in a patient with acquiredimmunodeficiency syndrome (AIDS)-is reported here.The diagnosis of Kaposi’s sarcoma and AIDS was confirmed in

October, 1983, in a 38-year-old homosexual man who, apart fromprimary syphilis in 1978, had no history of recurrent infectiousdiseases. In July, 1983, two sharply outlined, infiltrated, violet 2 x1 cm plaques were noted on the right hip. In October, biopsy of oneof the lesions revealed that the corium was infiltrated by numerousspindle cells surrounding predominantly slit-like small vascularlumina lined by large, protruding endothelial cells. Few mitoseswere seen. Hyaline bodies were present in the cytoplasm of thespindle cells. In the perivascular connective tissue there was aninflammatory infiltrate consisting of plasma cells and a few

lymphocytes. Extravasation of erythrocytes and haemosiderin

deposits were also seen. Tumour infiltrated the stratum papillare aswell as stratum reticulare surrounding the cutaneous adnexae. Thehistological diagnosis was Kaposi’s sarcoma.At the time of biopsy several enlarged lymph nodes were found in

the axillae and groins. Light microscopy of a lymph node removedfrom the right axilla revealed hyperplastic germinal centres withlymphocytoid cells and, in the cortex and paracortex, atypical vesselstructures without lumina and lined by factor VIII positiveendothelial cells. Ultrastructural studies (x 48 000) disclosedtubulovesicular rosettes’ in lymphoid cells. By flow cytometry(’FACS IV’) on 25 000 freshly obtained peripheral blood

lymphocytes the absolute ratio of helper to suppressor (Leu 3A andLeu 2A positive, respectively) T-lymphocytes was 0’ 3 in Octoberand 0.2 2 in December, 1983 (normal for the age group 2’0).From the beginning of November the patient was treated

exclusively with dapsone 100 mg daily. We tried dapsone because,in response to a paper on Kaposi’s sarcoma that we had delivered at ameeting in Oslo the previous June, Dr H. B. Svindland commentedthat he had used this drug successfully in such a case. After 6 weeksthe two Kaposi lesions had regressed and turned into brownish,atrophic scars. Neither cytostatic drugs nor radiotherapy weregiven. In December the whole of the previously examined Kaposilesion was excised. The epidermis was flattened but otherwisenormal. In the corium the stratum papillare was thickened owing topronounced fibrosis. Areas of haemosiderin deposits were seen. Nohistological features of Kaposi’s sarcoma were found.Except for tiredness and slight loss of weight the patient had no

symptoms during the observation period. X-ray examination of thechest was normal as well as blood lymphocyte counts and

immunoglobulin levels. The lymph nodes remained unchanged..

The aetiology of Kaposi’s sarcoma is unknown, but it has been

suggested that infective agents2,3 are important in the pathogenesisof this proliferative vascular disease. The early histologicalappearance of Kaposi’s sarcoma characterised by lymphocytes,plasma cells, and numerous vessels may imitate granulation tissue.Dapsone is used in leprosy and in several chronic inflammatorydermatoses without infectious aetiology. It is tempting to relatethetumour regression in this case to the treatment with dapsone.However, further studies are needed before dapsone can berecommended for the treatment of Kaposi’s sarcoma in patientswith AIDS.

Departments of Dermatologyand Pathology,

Finsen Institute,DK-2100 Copenhagen, Denmark

ASMUS POULSENBIRTHE HULTBERGKRISTIAN THOMSENGUNHILD LANCE WANTZIN

1. Ewing EP, Spira TJ, Chandler DVM, et al. Unusual cytoplasmic body in lymphoidcells of homosexual men with unexplained lyniphadenopathy N Engl J Med 1983,308: 819-22

2 Costa J, Rabson AS Generalised Kaposi’s sarcoma is not a neoplasm Lancet 1983; i58

3 Cartwl AR Kaposi’s sarcoma and variably acid-fast bacteria in vivo in two homosexual men. Cutis 1983; 32: 58-65

4 Pearson GL Sulfones and sulfonamides in dermatology today. Am Acad Dermatol1979; 1: 479-92

regression of kaposi's sarcoma in aids after treatment with dapsone

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