Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 5-1999. A 37-year-old man with fever and diffuse lymphadenopathy

Extracorporeal Membrane Oxygenation in Miliary Tuberculosis and AIDS: A Case Report

Background The aim of this study is to present the success of a multidisciplinary approach in a patient with a rare triad of disease.

Case Description A 33-year-old patient with newly diagnosed human immunodeficiency virus infection presented with miliary tuberculosis, consecutive adult respiratory distress syndrome, and multiple-organ failure. An interdisciplinary, time-limited approach combining extracorporeal membrane oxygenation, intensive care therapy, hemodiafiltration, tuberculostatic therapy, steroids, and antiretroviral therapy led to survival despite a low probability at presentation.

Conclusion Even though the use of such extensive and expensive treatment can be questioned, this example encourages an aggressive approach in a young patient, even in situations of multiple diagnosis of individually limited prognosis.

The Boston Health Care for the Homeless Program: a public health framework

During the past 25 years, the Boston Health Care for the Homeless Program has evolved into a service model embodying the core functions and essential services of public health. Each year the program provides integrated medical, behavioral, and oral health care, as well as preventive services, to more than 11 000 homeless people. Services are delivered in clinics located in 2 teaching hospitals, 80 shelters and soup kitchens, and an innovative 104-bed medical respite unit. We explain the program's principles of care, describe the public health framework that undergirds the program, and offer lessons for the elimination of health disparities suffered by this vulnerable population.