ABSTRACT
A young male homosexual was hospitalized at the Zurich University Hospital in March 1981. He suffered from oral candidiasis and bilateral pneumonia (Figure 48.1). Despite broad-spectrum antibiotic therapy, his condition deteriorated. Ten days later Pneumocystis was found in a transbronchial lung biopsy specimen. Shortly after the initiation of cotrimoxazole treatment the patient developed an ARDS-like picture and had to be mechanically ventilated because of respiratory failure. He died 9 days later. Although the physicians wisely suspected some kind of cellular immunodeficiency, the reason for this strange infection in an otherwise healthy young man remained
unclear. Until that time Pneumocystis was found only sporadically, and it usually occurred in patients suffering from neoplasias treated with cytotoxic therapies. Nine months later 15 similar cases among homosexuals or intravenous drug users were reported.1, 2 Eight patients died within a short time. In the others, a persistent cellmediated immune defect was documented. However, it took another 2 years until the human immunodeficiency virus (HIV) was found to be the reason for this new immune deficiency syndrome.3, 4 Subsequently, a new variant was isolated in patients with West African connections. This HIV-2, however, has remained rare.
