874
CORRESPONDENCE
Treatment of Intestinal Cryptosporidiosis With Zidovudine and SMS 201-995, a Somatostatin Analog Dear Sir: The report by Greenberg et al. (1) about resolution of intestinal cryptosporidiosis after treatment of one patient with the acquired immunodeficiency syndrome (AIDS) with zidovudine postulates that the beneficial effect was secondary to prior improvement of immune functions. We observed a resolution of a cryptosporidial infection in an immunosuppressed patient despite zidovudine therapy. A 23-year-old heterosexual French man was admitted in November 1989 because of a Z-month history of severe diarrhea, weight loss (10 kg), and fever. This patient had six watery bowel movements daily despite loperamide treatment. Stool samples showed cryptosporidial oocysts. He was seropositive for human immunodeficiency virus (HIV 1) by Western blotting. Results of stool examination were negative for other infectious agents. Sigmoidoscopy showed mucosal edema, and colonic biopsies showed no evidence of herpes simplex virus or cytomegalovirus infection. Laboratory data showed malabsorption [protidemia, 54 g/L; albuminemia, 25 g/L; serum calcium, z mmol/L; blood n-xylose level z hours after 25 g oral load, 0.16 giL (normal, >0.25 g/L); Schilling test with intrinsic factor: 1.5% (normal, > lo%), steatorrhea, 21 gi2.4 h]. Analysis of lymphocyte phenotypes showed 180 CD4/pL. Treatment with zidovudine (1000 mgiday) was started 1 week after admission. Because of no improvement in clinical and laboratory data 3 weeks after initiation of zidovudine, SMS 201-995, a somatostatin analog, was introduced [progressive dose up to a maximum dose of 200 p&2 h). Stool volumes fell in 15 days. Interruption of this treatment was marked by reappearance of diarrhea, which stopped with reintroduction of SMS 201-995. Repeat stool examinations showed no cryptosporidia. Lymphocyte subsets were quantitated and showed 150 CD4/uL. Treatment with SMS 201-995 was discontinued and the patient discharged in January 1990. He was asymptomatic 6 months later, and his CD4 cell count was 38ipL. In our report, progressive disappearance of diarrhea, malabsorption, and cryptosporidia in stools coincided with SMS 201-995 treatment, despite improvement of the immune functions. We doubt that zidovudine alone permitted resolution of this coccidial infection. The efficacy of SMS 201-995 has been reported in five cases in the literature (2-5). Eradication of oocysts was noted in one case (3). The value of SMS 201-995 must be ascertained by large-scale assays. JEAN BAPTISTE NOUSBAUM, M.D. MICHEL ROBASZKIEWICZ, M.D. JEAN MICHEL CAUVIN, M.D. MICHEL GARRE, M.D. HERVE GOUEROU, M.D.
Service de Gastroentkologie and Unit& de Maladies Infectieuses C.H. U. Mot-van, 5 avenue Foch 29285 Best Cedex, France 1. Greenberg RE, Mir R, Bank S, Siegal FP. Resolution of intestinal cryptosporidiosis after treatment of AIDS with AZT. Gastroenterology 1989;97:1327-1330. 2. Casals A, Lorente L, Jou A, Clotet B. Utilidad de un analog0 de la somatostatina en el tratemiento de la diarrea grave por criptosporidium. Med Clin (Bare) 1989;92:358-359. 3. Clotet B, Sirera G, Cofan F, Montorela JM, Tortosa F, Foz M. Efficacy of the somatostatin analogue (SMS-201-995), sandostatin, for cryptosporidial diarrhoea in patients with AIDS. AIDS 1989;3:857-858.
GASTROENTEROLOGY
Vol. 101, No. 3
4. Cook DJ, Kelton JG, Stanisz M, Collins SM. Somatostatin treatment for cryptosporidial diarrhoea in patient with the acquired immunodeficiency syndrome (AIDS). Ann Intern Med 1988;108:708-709. 5. Katz MD, Erstad BL, Rose C. Treatment of severe cryptosporidium related diarrhoea with octreotide in a patient with AIDS. Drug Intel1 Clin Pharm 1988;22:134-136.
Somatostatin Hemorrhage
and Acute Variceal
Dear Sir: We read with great interest the article by Burroughs et al. (1) on the efficacy of somatostatin for emergency control and prevention of early variceal rebleeding. The results of this large placebocontrolled, double-blind trial are quite convincing. Successful termination of bleeding occurred in about 60% of subjects receiving a 5-day continuous infusion of somatostatin and in
CORRESPONDENCE
Treatment of Intestinal Cryptosporidiosis With Zidovudine and SMS 201-995, a Somatostatin Analog Dear Sir: The report by Greenberg et al. (1) about resolution of intestinal cryptosporidiosis after treatment of one patient with the acquired immunodeficiency syndrome (AIDS) with zidovudine postulates that the beneficial effect was secondary to prior improvement of immune functions. We observed a resolution of a cryptosporidial infection in an immunosuppressed patient despite zidovudine therapy. A 23-year-old heterosexual French man was admitted in November 1989 because of a Z-month history of severe diarrhea, weight loss (10 kg), and fever. This patient had six watery bowel movements daily despite loperamide treatment. Stool samples showed cryptosporidial oocysts. He was seropositive for human immunodeficiency virus (HIV 1) by Western blotting. Results of stool examination were negative for other infectious agents. Sigmoidoscopy showed mucosal edema, and colonic biopsies showed no evidence of herpes simplex virus or cytomegalovirus infection. Laboratory data showed malabsorption [protidemia, 54 g/L; albuminemia, 25 g/L; serum calcium, z mmol/L; blood n-xylose level z hours after 25 g oral load, 0.16 giL (normal, >0.25 g/L); Schilling test with intrinsic factor: 1.5% (normal, > lo%), steatorrhea, 21 gi2.4 h]. Analysis of lymphocyte phenotypes showed 180 CD4/pL. Treatment with zidovudine (1000 mgiday) was started 1 week after admission. Because of no improvement in clinical and laboratory data 3 weeks after initiation of zidovudine, SMS 201-995, a somatostatin analog, was introduced [progressive dose up to a maximum dose of 200 p&2 h). Stool volumes fell in 15 days. Interruption of this treatment was marked by reappearance of diarrhea, which stopped with reintroduction of SMS 201-995. Repeat stool examinations showed no cryptosporidia. Lymphocyte subsets were quantitated and showed 150 CD4/uL. Treatment with SMS 201-995 was discontinued and the patient discharged in January 1990. He was asymptomatic 6 months later, and his CD4 cell count was 38ipL. In our report, progressive disappearance of diarrhea, malabsorption, and cryptosporidia in stools coincided with SMS 201-995 treatment, despite improvement of the immune functions. We doubt that zidovudine alone permitted resolution of this coccidial infection. The efficacy of SMS 201-995 has been reported in five cases in the literature (2-5). Eradication of oocysts was noted in one case (3). The value of SMS 201-995 must be ascertained by large-scale assays. JEAN BAPTISTE NOUSBAUM, M.D. MICHEL ROBASZKIEWICZ, M.D. JEAN MICHEL CAUVIN, M.D. MICHEL GARRE, M.D. HERVE GOUEROU, M.D.
Service de Gastroentkologie and Unit& de Maladies Infectieuses C.H. U. Mot-van, 5 avenue Foch 29285 Best Cedex, France 1. Greenberg RE, Mir R, Bank S, Siegal FP. Resolution of intestinal cryptosporidiosis after treatment of AIDS with AZT. Gastroenterology 1989;97:1327-1330. 2. Casals A, Lorente L, Jou A, Clotet B. Utilidad de un analog0 de la somatostatina en el tratemiento de la diarrea grave por criptosporidium. Med Clin (Bare) 1989;92:358-359. 3. Clotet B, Sirera G, Cofan F, Montorela JM, Tortosa F, Foz M. Efficacy of the somatostatin analogue (SMS-201-995), sandostatin, for cryptosporidial diarrhoea in patients with AIDS. AIDS 1989;3:857-858.
GASTROENTEROLOGY
Vol. 101, No. 3
4. Cook DJ, Kelton JG, Stanisz M, Collins SM. Somatostatin treatment for cryptosporidial diarrhoea in patient with the acquired immunodeficiency syndrome (AIDS). Ann Intern Med 1988;108:708-709. 5. Katz MD, Erstad BL, Rose C. Treatment of severe cryptosporidium related diarrhoea with octreotide in a patient with AIDS. Drug Intel1 Clin Pharm 1988;22:134-136.
Somatostatin Hemorrhage
and Acute Variceal
Dear Sir: We read with great interest the article by Burroughs et al. (1) on the efficacy of somatostatin for emergency control and prevention of early variceal rebleeding. The results of this large placebocontrolled, double-blind trial are quite convincing. Successful termination of bleeding occurred in about 60% of subjects receiving a 5-day continuous infusion of somatostatin and in
