Getting patients well, keeping them well, and focusing on a cure

The following letter was written by J.O. Warner in the journal, Lancet, August 24, 1985, page 447 regarding the successful use of amantadine for cervical lymphadentitis in his patient with CGD.

Sir, - Dr. Segal’s excellent paper (June 15, p. 1378) arrived just as I was puzzling over what other treatment I could offer to a child with major problems related to his chronic granulomatous disease (CGD). As a result of Segal’s suggestions this patient’s condition has improved considerably.

The patient is now aged 4 years and 9 months. He presented at 6 months of age with a persistent pneumonia resistant to standard antibiotic therapy and lacking a definitive bacteriological diagnosis. Eventually, Pseudomonas aeruginosa infection was diagnosed and antibiotics resulted in clearing of the pneumonia. He was investigated for underlying causes of the pneumonia and found to have CGD. He also has haemoglobin SC disease* and heterozygous glucose-6-phosphate dehydrogenase deficiency. He has been treated with prophylactic trimethoprim (cotrimoxazole being precluded by the G-6-PD deficiency). Over the past four years his progress has been punctuated by recurrent cervical lymphadentitis. For the past 18 months he has had persistent swelling of the submandibular and anterior and posterior triangle glands. These have been hard and matted and one gland in the left posterior triangle required drainage. The wound healed rapidly. Despite repeated courses of both oral and intravenous antibiotics no reduction in the size of the glands was achieved.

Having read Segal’s article, I put this boy on oral amantadine 25 mg twice daily. In the 6 weeks since the introduction of this therapy the cervical glands have rapidly diminished in size and are now smaller than they have ever been in the past 18 months. This supports Segal’s suggestion that abnormally acidic conditions within the phagocytic vacuole profoundly affect intracellular metabolism and perhaps also the primary abnormality of defective organism killing.

Have any other clinical studies been done with amantadine in children with CGD? It will also be of interest to know whether therapeutic amantadine reverses the organism-killing defect. This is now being investigated in the above patient.

*A disease of persons who have inherited two abnormal forms of hemoglobin, S and C. The symptoms include hematuria and pain in the bones, joints, abdomen, and chest.

[Ed. Note: This therapy was based on A.W. Segal’s excellent article, .Variations on the Theme of Chronic Granulomatous Disease. in Lancet, 1985, pages 1378-82. It was suggested by one doctor that the amantadine makes the cells more receptive to antibiotic treatment. If you or your patient have used amantadine, your comments on whether it helped or not, are greatly appreciated. Over the years, it has been found that many doctors have been reluctant to give amantadine to their CGD patients, because the common use for this medication is for influenza. It is hoped that some surgeries could be avoided by the use of amantadine for cervical lymphadentitis.]