Pregnenolone acetate in treatment of mycetoma

miquelangeles

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THE PURPOSES of this presentation are (1) to report a case of mycetoma (nocardiosis) in a child who had failed to respond to all the standard forms of therapy and who apparently has been cured by treatment with pregnenolone acetate and (2) to call attention to pregnenolone acetate as an agent free from undesirable metabolic or toxic effects, which has useful antifungal properties that warrant further clinical investigation.

BACKGROUND

The ideal antifungal drug would be one which could be used both locally and orally, which would diffuse through sweat, the nail bases, and the sebum of the hair follicles and which would thus attack the fungus from within as well as without, with no toxicity to the host. Some reports are already in the literature on the toxicity of certain new antifungal drugs used topically in young children.

Our studies indicate, however, that there are certain steroids with little if any metabolic effect, even in children, which show some antifungal properties. Reiss,(1) Dobes,(2) and others have reported the in vitro and in vivo inhibitory effect of various steroid hormones, including testosterone and estrogen, on certain dermatophytes and other pathogenic fungi.

These systemically active hormones are not practical for use against chronic mycotic infections in children. In the adult female there is the danger of interrupting the menstrual cycle with the estrogens and of developing hirsutism with testosterone. In the adult male there is the danger of suppressing spermatogenesis with testosterone and of developing feminizing symptoms with the estrogens. Pregnenolone acetate, a steroid compound that has been used in arthritis, has been shown by numerous investigators 5 to have little metabolic effects in large dosage. For this reason, it was employed in treating a child with mycetoma (nocardiosis) who had failed to respond to all the standard modes of therapy. The dramatic results have prompted us to make this report.

SUMMARY


Pregnenolone acetate administered orally in a dosage of 200 or 300 mg. daily for eight months (a total dose of about 60 gm.) produced an apparent cure in a case of intractable mycetoma in a child .6 years of age, thus preventing eventual amputation. The medication in this large dosage produced no systemic manifestations and no evidences of metabolic activity or toxicity. The organism isolated from the mycetoma was identified as an atypical strain of Nocardia asteroides.
 

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