A case of acquired immunodeficiency syndrome (AIDS) in a homosexual man.

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  • Hagiwara Koichi
    Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital
  • Kudo Shoji
    Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital
  • Kasama Asahiko
    Department of Anesthesilolgy, Tokyo Metropolitan Komagome Hospital
  • Hsu Lung-Hung
    Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital
  • Hirayama Masakiyo
    Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital
  • Uetake Takeshi
    Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital
  • Kimura Hitoshi
    Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital
  • Minamitani Mikio
    Department of Infectious Diseases, Tokyo Metropolitan Komagome Hospital
  • Koike Morio
    Department of Pathology, Tokyo Metropolitan Komagome Hospital

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  • Ｐｎｅｕｍｏｃｙｓｔｉｓ　ｃａｒｉｎｉｉ，Ｃｙｔｏｍｅｇａｌｏｖｉｒｕｓ肺炎により死亡した日本人男性同性愛者にみられた後天性免疫不全症候群（ＡＩＤＳ）の１例

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Abstract

A 44 year-old man was transferred to our hospital on July 17, 1985, for treatment of pneumonia and respiratory failure. He had been hospitalized elsewhere on June 24, 1985, because of fever and dyspnea. He had been treated with several kinds of antibiotics there, but no improvement was noted.<br>On admission, he appeared cachectic and cyanotic. Four foci of fungal skin infections were found. The arterial oxygen tension with 1.5l/min oxygen by nasal cannula was 30. The white-cell count was 6300, with only 4 per cent lymphocytes. A chest film showed bilateral diffuse infiltration with air bronchogram.<br>Despite intensive oxygen and antibiotic therapies, the patient's condition deteriorated. A three-day course of high dose methylpredonisolone therapy (1g/day) was also ineffective.<br>On July 31, bronchial washing performed under ECMO (extracorporeal membrane oxygenation) revealed many cytomegalovirus-inclusion cells and Pneumocystis carinii organisms. On the same day, the patient's colleagues in formed us that the patient had homosexual relationships for more than four years. He lived with a man from New Zealand from 1981 to 1983. In addition, he was a member of the gay community in the Shinjuku area.<br>The patient died on August 1. An autopsy showed heavy and firm lungs (right 2125g, left 975g) with liver-like appearance on its cut surface. Microscopic examination revealed Pneumocystis carinii pneumonia, cytomegalovirus infection of the lung, adrenal, pancreas, prostate, gastric mucosa, and liver, and Herpes simplex skin infection of the scrotum. There was no evidence of malignancy. Further laboratory examination of the premortem specimens showed the marked decrease in the ratio of the lymphocyte subsets (Leu 3a/Leu 2a=0.09) and the presence of AIDS virus antibody.<br>Final diagnoses were 1. AIDS 2. Pneumocystis carinii pneumonia 3. Systemic cytomegalovirus infection 4. Tinea corporis due to trichophyton 5. Skin erosion of the scrotum due to Herpes simplex.

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