A young man at the Chateau Marmont had been coughing
for two weeks. He had a fever, and my stethoscope revealed lung noises typical
of pneumonia.
I enjoy diagnosing pneumonia because, in an otherwise
healthy person, it’s the only common illness with a cough that doctors can
cure. Everything else is a virus.
I didn’t like this particular diagnosis. It takes a
tough germ to cause pneumonia in most people, so unpleasant symptoms begin
quickly. This man’s cough had persisted for some time. Furthermore, he was gay
and admitted to having unprotected sex. I suspected that he had a pneumocystis
infection. Pneumocystis is a fungus so benign that it lives in the lungs of
most of us, causing no trouble.
Until forty years ago, it was rare, affecting patients
already sick with cancer or serious diseases requiring drugs that suppressed
immunity. Doctors were mystified when Pneumocystis began attacking previously
healthy young men during the 1980s. It turned out to be the most common sign of
AIDS.
It’s rare again today because we track immune cells of
HIV patients and prescribe preventive drugs when the numbers drop. This young
man had not been tested, but he was no fool. He cut short his visit and
returned home.
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