Empiricism and Wegener's Granulomatosis

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Abstract
Many medical treatments are based on sheer empiricism. In 1975 I noted that trimethoprim–sulfamethoxazole had a salutary effect in a woman with Wegener's granulomatosis involving all major sites, including the upper respiratory tract, lungs, and kidneys. I had given her the drugs to treat a urinary tract infection, reasoning that standard immunosuppressant therapy with a glucocorticoid and cyclophosphamide would cause a disseminated infection. Since the disease had a somewhat indolent course, I elected first to treat the urinary tract infection, which was due to Escherichia coli sensitive to trimethoprim–sulfamethoxazole. Curiously, the disease came under control at all sites. During the . . .