Aggressive Treatment of a Patient with the Acquired Immunodeficiency Syndrome

Excerpt

To the editor: A 28-year-old homosexual man with respiratory distress, diagnosed with Pneumocystic carinii pneumonia and psittacosis, was intubated on day 7. Complications during weeks 3 to 9 included gastrointestinal bleeding requiring transfusion, recurrent pneumothoraces requiring bilateral chest tubes, tracheostomy placement, pseudomonas sepsis, and disseminated cytomegalovirus. After extubation he was febrile to 40 °C and maintained on trimethoprim, dapsone, imipenem, ceftriaxone, and intravenous acyclovir. By week 15, stool cultures taken at week 5 were reported positive for Mycobacterium avium intracellulare. He was discharged at week 16, requiring home central hyperalimentation, intravenous antibiotics, oxygen, blood and electrolyte replacements, meticulous skin care,