Combination immunotherapy in chronic mucocutaneous candidiasis synergism between transfer factor and fetal thymus tissue

A child with chronic mucocutaneous candidiasis and hypothyroidism was found on immunological evaluation to have significant deficits of cell-mediated immunity. Skin anergy and absent lymphocyte transformation to specific antigens as well as failure to produce a lymphokine (macrophage migration inhibitory factor) by antigen-stimulated lymphocytes were observed. Immune responses to mitogens and allogeneic cells were normal. Two courses of combined transfer-factor therapy and amphotericin B did not result in clinical improvement or changes in immunologic function. A 20-week-gestation fetal thymus was transplanted intraperitoneally. Because of persistent deficits in cell-mediated immune function 3 months after thymus transplantation, transfer-factor therapy was reinstituted. Shortly thereafter, lymphocyte proliferative responses to specific antigens developed for the first time. After a partial clinical relapse, a second fetal thymus, 18-weeks gestation, was transplanted concomitant with vigorous transfer-factor therapy. Without further chemotherapy, delayed skin reactivity became positive with clearing of all candidal skin lesions. The success of the combination immunotherapy which resulted in clinical improvement and immunologic reconstitution may have been achieved by the synergistic interaction of transfer factor with the fetal thymus.