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[Odler]

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No one could guess why Mr. V. was having fever. He was on the ward for a week and underwent a one-million-dollar work-up that brought no result.

Mr. V. is a venerable retired high school principal, active all his life in community affairs, in boards, and in political committees. He is respected by his seven children, adored by his 24 grand-children, and veneered by a larger number of great grand children. He is the typical patriarch.

We sent tests for pneumonia, tuberculosis, cancer, arthritis, mixed connective tissue diseases; all the results came back negative. And, Mr. V still felt sick and febrile. His temperature would sometimes rise to as high as 105 Fahrenheit degrees.

Mr. V had never been sick before in his life. He had an appendectomy as a child. About 30 years ago, he developed diabetes mellitus. He has been taking small doses of insulin since then. He never missed one day, he never missed one dose.

Mrs. V, the matriarch, married to the great man for 56 years, in the days when she was a teenager, grew anxious under her exterior of dignity. ?Doctor? was she saying ?we need to find out. Don?t we?? We did not have an answer for her. We said: ?Yes, madam, we do.? And, the dance of tests and X-rays continued.

One day, someone suggested we should test for HIV. That was a ridiculous idea. The man is old; he was already 60 when the first AIDS cases were diagnosed. He never did drug, he never had a blood transfusion. He is the paragon of marital fidelity. He never looked at a woman who was not his wife.

It is like suggesting that Al Gore would be HIV infected.

We were quite embarrassed to ask him for his consent. We did. We sent the specimen out, and continued testing for more likely reasons, such as West Nile virus, and Ecchynococcus granulomatosis granuloma that no one ever has. We almost forgot about the HIV test.

Four days later the results came back. Mr. V was HIV positive. His viral count was high. His CD4 count was too low. He had AIDS!

A careful history revealed that his young grand-daughter, who died of AIDS three years ago, was using his diabetic needles to shoot drugs, then would place them back in the box?

Please, visit: http://www.jeanlouie.com/

(Odler R. Jeanlouie, Sunday, July 13, 2003)