Giant, human immunodeficiency virus-related ulcers in the esophagus

Human immunodeficiency virus (HIV) infection of the esophagus has recently been implicated as a cause of giant esophageal ulcers in HIV-positive patients with odynophagia. The authors examined four patients in whom esophagograms (one single-contrast and three double-contrast studies) revealed giant, HIV-related ulcers indistinguishable from those of cytomegalovirus (CMV) esophagitis. All four patients had severe odynophagia, one had an associated maculopapular rash, and two became HIV-positive at approximately the time of clinical presentation. In all patients, biopsy samples, brushings, and cultures obtained with endoscopy were negative for CMV or herpes simplex. One patient had positive brushings for candidiasis, but this may have resulted from fungal superinfection of the ulcer. Two patients were treated with orally administered steroids, and all four had swift clinical improvement; symptoms disappeared during an average period of 8.3 days from presentation. HIV-related esophageal ulcers should be distinguished from CMV ulcers, so that appropriate treatment can be initiated in these patients.