Disseminated Candidiasis in Drug Abusers

To the Editor.  —We read with interest the recent report in the Archives of two alcohol abusers with disseminated candidiasis and macronodular skin lesions.¹ We and others have reported a distinctive syndrome of disseminated candidiasis that occurs in heroin abusers,^2,3 and that has a number of features similar to those in the cases reported. In heroin abusers the most distinctive feature of the syndrome was skin lesions. These lesions consist of nodules predominantly in the scalp area that on occasion could discharge purulent material cutaneously. In addition, multiple smaller pustules were frequently found, principally associated with hair-bearing areas over the entire body. Candida albicans was readily cultured from these lesions. In addition, fever, abnormal liver enzymes, markedly raised anticandidal antibodies, costochondritis, eye involvement, and bone involvement were common.While the distribution of the described skin lesions in the report¹ does not appear to be the same