Hooked on Rheum with Gregg J. Silverman, MD
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During my first year of medical school, I was accepted into the U.S. Public Health Service Commissioned Officer Student Training Extern Program (COSTEP). During my 1978 and 1979 summer breaks, I was stationed at the NIH Clinical Center.
My first week, I went to the information desk and asked what floor was dedicated to clinical immunology. They referred me to the in-patient floor of the National Institute of Allergy and Infectious Diseases, and I went on weekly rounds led by Anthony S. Fauci, MD. On these rounds, we discussed conditions such as Wegener’s granulomatosus, midline granuloma, cyclic neutropenia and eosinophilic pneumonitis. We also discussed what were described as uncommon infections: CMV encephalitis, disseminated herpes zoster (HZ) and pneumocystis. Sometime later, it was realized these were amongst the earliest AIDS cases.
Being an eager medical student, I volunteered to assist in the first in vivo treatment with IV acyclovir. Every day, I surveyed the patient’s skin for new HZ vesicles, which I then circled and dated with a marker, and aspirated with a tuberculin syringe. After approximately 5 days of treatment, the vesicles clouded over, and the virus was no longer viable. Three days later, the patient awoke from her coma. She was quite vocal about her dislike of the restraints, but it was clear that her mental status had markedly improved.
During the following summer, I was the clerk on the Infectious Disease Consult Service, and Dr. Fauci was the attending and Thomas R. Cupps, MD, was my fellow. I waded through the massive charts of in-patients who had the broadest range of inherited and acquired diseases imaginable. I have never seen such a collection of medical “zebras”. Yet, they all shared the same problem: a new fever since admission. It took me some time to also understand that most had the same infection — non-A, non-B hepatitis. It was only a matter of time that the responsible virus would be isolated and sequenced. These watershed months all preceded my third year in medical school.
– Gregg J. Silverman, MD
Director, Laboratory of B Cell Immunobiology
Professor of Medicine and Pathology
NYU Langone School of Medicine