In 1983, when the term AIDS was still new and the understanding of the disease was limited, a 30-year-old intravenous drug user was admitted to the hospital where a third-year medical student was assigned to work-up the admission. The patient had lost 40 pounds over the past several months, a persistent cough, shortness of breath, night sweats, significantly enlarged lymph nodes, and several reddish-purple lesions on his legs, as well as a dark lesion on his hard palate. A diffuse bilateral infiltrate was seen on his chest X-ray, and he was in moderate respiratory distress, so he was started on oxygen.

The next morning, the Chief of Medicine, Dr. Eugene Braunwald, accompanied the team on rounds. The resident presented the case and confidently diagnosed AIDS, which everyone agreed with except for the medical student. The student’s differential diagnosis included AIDS or Intravenous Talcosis, which caused some laughter among the team. The student explained that a differential diagnosis needs to include more than one option, so if it isn’t AIDS, then Intravenous Talcosis is the only other option that fits the patient’s symptoms. The patient used crushed pills, which can be a source of talc. Dr. Braunwald nodded and proceeded to examine the patient.

Diagnostic tests were conducted, and it was found that the patient had Mycobacterium Tuberculosis and Intravenous Talcosis. The patient was treated and recovered fully, and the student received a nice letter of recommendation from Dr. Braunwald. The spots on his legs were ringworm, and the spot on his hard palate was benign.