An HIV-infected patient may develop a giant ulceration in the esophagus. It is essential to determine the cause, since this will determine the most effective management.
Clinical features:
(1) painful swallowing (odynophagia)
(2) acute substerrnal chest pain
(3) hematemesis or GI bleeding
(4) single large ulceration or multiple small ulcerations in the mid to distal esophagus
(5) superinfection of the ulcers by Candida albicans may occur
|
Possible Cause |
Feature |
Therapy |
|
CMV |
intranuclear inclusions or positive viral cultures |
anti-viral agents |
|
HSV |
intranuclear inclusions or positive viral cultures |
anti-viral agents |
|
medication-related |
history and type of oral medications |
change in formulation, drug regimen or route of administration |
|
HIV |
exclusion of other causes |
oral corticosteroids |
|
mycobacteria |
acid fast bacilli and culture |
anti-mycobacterial agents |
|
nasogastric intubation or endoscopy |
history of recent intubation or endoscopy attempt |
|
|
caustic ingestion |
chemical burn of lips, mouth and esophagus |
|
|
radiation therapy |
history of radiation therapy to chest |
|
where:
• Some cases of HIV-related ulceration will occur as part of the primary infection.
Purpose: To evaluate an HIV-positive patient with a giant esophageal ulceration.
Specialty: Gastroenterology
Objective: clinical diagnosis, including family history for genetics, complications
ICD-10: B23.8, K22.1,
