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Volume 13 Number 5, Part I November, 1985 history of intestinal disorders.' Patients experiencing abdominal pain, rectal bleeding, or severe diarrhea are advised to discontinue therapy promptly. Our group has now treated over one hundred patients with oral isotretinoin and we have observed no gastric adverse reactions. Asked whether a history of inflam- matory bowel disease should be considered a contrain- dication to the use of isotretinoin, a gastroenterology consultant writing in the Journal of the American Med- icalAssociation stated that neither he nor his colleagues have observed one case in which ulcerative colitis or Crohn's disease has occurred following the use of this medication.' I recently treated a patient afflicted with cystic acne and ulcerative proctitis with oral isotreti- noin. No deleterious effect upon the gastrointestinal tract was noted. Case report. A 19-year-old man presented with cystic acne involving his face and neck. In 1980 he had developed abdominal pain, weight loss, and constipation associated with passage of blood and mucus. Sigmoidoscopy revealed edema and friable tissue and rectal biopsy showed evidence of mu- cosal ulceration and crypt abscesses, consistent with a di- agnosis of ulcerative colitis. He was placed on sulfasalazine, 2 gm/day, with intermittent flare-ups requiring short courses of oral prednisone. Because of gastric intolerance to tetra- cycline and erythromycin, he was placed on ampicillin, 1gmt day, in an attempt to control his severe cystic acne. The condition improved over the next 6 months but then flared, and in August 1983 he was placed on 80 rug/day of oral isotretinoin. Two weeks later a marked flare of the acne oc- curred. The isotretinoin dosage was decreased to 40 mg/day, ampicillin was again added, and the lesions were injected with triamcinolone. Within 2 weeks his condition had sta- bilized and the dosage of isotretinoin was increased to 80 rng/ day. He remained on this dosage for the next 14 weeks. During the entire course of isotretinoin he experienced no gastric or rectal abnormalities. Indeed, after the third month his dosage of sulfasalazine was cut in half. All laboratory values, including serum triglycerides, remained within normal range. As of January 1985 no new cystic lesions had been ob- served. Further, the patient had not experienced any cxac- erbation of the colitis and had been off sulfasalazine for over 6 months. Comment. The use of oral isotretinoin does not ap- pear linked to the onset of ulcerative colitis or Crohn's disease. Similarly, in patients with inflammatory bowel disease, isotretinoin therapy may not lead to exacer- bation and would be indicated in the treatment of such persons also afflicted with cystic acne. Stephen M. Schleicher, M.D. Ste. 2, 8945 Ridge Ave. Philadelphia, PA 19128 Correspondence 835 REFERENCES I. Physicians' Desk Reference. Oradell, NI, 1985, Medical Economics Co., pp. 1665-1667. 2. Korelitz BI: Systemic 13-cis-retinoic acid therapy and ex- acerbation of colitis. JAMA 252:2463, 1984. Gnathostomiasis (nodular migratory eosinophilic panniculitis) To the Editor: In 1979, gnathostomiasis (nodular migratory eosin- ophilic panniculitis) was detected for the first time in Guayaquil (Ecuador, South America). I Its existence was confirmed in 1981 by the Department of Derma- tology, Venereology and Allergy of the Institute Ecua- toriano de Seguridad Social of Guayaquil, Ecuador, when the third parasite stage in humans (Fig. 1) was discovered for the first time in South America.v' In 1985 we found the Gnathostoma parasite, in its adult stage, in the stomachs of its definitive hosts, dogs and cats (Fig. 2). This was also reported for the first Fig. 1. Third stage of the parasite found inhuman tissue. Fig. 2. Parasite in its adult form found in the stomach of a cat (definitive host).
