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A case of disseminated infection with Pneumocystis carinii is presented, and the Englishlanguage literature is reviewed for cases of documented extrapulmonary infection with this organism. In this case- with P. carinii diffusely replacing the bone marrow and causing hepatic, adrenal, and glomerular tuft necrosis - the clinical illness and multiple-organ dysfunction attributed to disseminated P carinii were more severe than had previously been described. Because the rate of extrapulmonary R carinii infection found at autopsy in patients with AIDS is at least 2.5% at our institution, we caution against the routine use of aerosol rather than parenteral pentamidine for treatment of P carinii pneumonia until additional data are available. Pneumocystis carinii is the most common agent causing opportunistic infection in patients with AIDS. Over 60% of patients with AIDS reported to the Centers for Disease Control have presented with P carinii pneumonia (PCP) as their initial op

To the Editor.— Zidovudine (azidothymidine) received Food and Drug Administration marketing approval on March 19, 1987. Before this, we received zidovudine from the National Institutes of Health for treating patients with acquired immunodeficiency syndrome who had recovered from one or more episodes of histologically confirmed Pneumocystis carinii pneumonia. To date, the most serious side effects that have been reported for zidovudine include severe anemia, granulocytopenia, or thrombocytopenia, sometimes requiring recurrent transfusions or interruption of therapy. Other reported side effects include rashes, asthenia, nausea, insomnia, myalgia, headache, and confusion. 1-4 Hepatic enzyme abnormalities in both placebo and zidovudine recipients were reported by Richman and colleagues. 4 They observed an aspartate aminotransferase (AST) concentration above 2500 U/L in one of 145 zidovudine recipients, while in 7% of the placebo recipients the AST concentration rose above 2500 U/L. Elevations of alkaline phosphatase concentration were also more common in placebo recipients. Since October 1986