AIDS in a Danish surgeon (Zaire, 1976) [letter]
This article describes the case of a previously healthy, 47-year old Danish woman who worked as a surgeon in a primitive rural hospital in Zaire in 1972-77. During her stay in Africa, she had repeated episodes of diarrhea. In 1976, fatigue, wasting, and universal lymphadenopathy emerged. Severe acute dyspnea beganin in 1977, and chest x-ray showed bilateral pulmonary infiltrates. A lung biopsy revealed nonspecific alveolar hyperplasia with enlarged macrophages. Oral candidiasis also developed. Laboratory tests indicated lymphocytopenia, low numbers of T-cells, decreased lymphocyte transformation responses, and no autoimmune disease. Respiratory insufficiency led to the patient's death in December 1977. Necroscopy showed bilateral pulmonary alveolar proteinosis with numerous Pneumocystis carinii. The patient recalled encountering at least 1 case of Kaposi's sarcoma in her work in Zaire, where she was likely heavily exposed to blood and excretions of patients. Although T4/T8 studies were not done, the cutaneous anergy and the Pneumocystis pneumonia strongly suggest an acquired deficiency of cellular immunity. This case raises the possibility of a connection between African and American acquired immunodeficiency syndrome (AIDS)/Kaposi's sarcoma. The underlying cause may be an as yet undetected, slow-acting African virus introduced to the US, perhaps via Haiti.