Plasma methionine enkephalin concentration and prognosis in primary biliary cirrhosis.

Maloprim by the patient had near fatal results.Pyrimethamine was taken by all four patients, suggesting that this may have been the toxic agent.Previous workers assumed that the sulphonamide component of Fansidar was responsible for the pulmonary toxicity.'In one report a lymphocyte trans- formation test yielded positive results in the presence of sulfadoxine but also with pyrimethamine, perhaps suggesting that non-specific cell activation had occurred.3We were unable to show lymphocyte activation with either dapsone or pyrimethamine, but this was assessed in only one patient and then only after she had recovered and taken steroids.Dapsone, the other constituent of Maloprim, is structurally related to the sulphonamides.Nevertheless, despite its widespread use it has not been reported to cause pulmonary eosinophilia.Similarly there are no reports of pul- monary toxicity with chloroquine.Three further cases of pulmonary eosinophilia, one confirmed by lung biopsy, have been reported to Wellcome Research Laboratories in patients who had taken Maloprim, and two cases of pulmonary toxicity with systemic features have been reported in patients who had taken pyri- methamine-chloroquine (L Maskell, personal communication).We therefore believe that pyrimethamine may cause pulmonary eosinophilia.We thank Dr W D Riding and Dr J 0 Hunter for permission to report cases 3 and 4; Mr M V Braimbridge for obtaining the lung biopsy specimens; Dr L Delgardo for performing the lymphocyte transformation test; and Dr D B A Hutchinson, Wellcome Research Laboratories, for supplying Maloprim.Daraclor is no longer available in the United Kingdom.