What are the most common causes of esophageal ulceration in HIV-infected patients?
- The most common causes are CMV and idiopathic esophageal ulcer (IEU). On endoscopy, CMV and IEU appear most often as multiple, large, well-circumscribed solitary ulcerations, with normal-appearing surrounding mucosa.
- Herpes simplex virus (HSV) is usually associated with multiple small, shallow esophageal ulcerations, often raised with a volcano crater appearance.
- GERD can also present with ulcerations of the distal esophagus generally involving the gastroesophageal junction; these lesions are generally linear and superficial.
- Neoplasms (e.g., lymphoma), parasites (e.g., leishmania), and fungal infections (e.g., histoplasmosis and Candida spp.) are rare causes of esophageal ulcers
Reported Causes of Esophageal Ulcers in AIDS
Viruses | Cytomegalovirus, herpes simplex virus type II, Epstein-Barr virus, papovavirus, human herpes virus-6 |
Fungi | Candida spp., Histoplasma capsulatum, Cryptococcus neoformans, mucormycosis, aspergillosis, Penicillium chrysogenum, Exophiala jeanselmei |
Bacteria | Mycobacterium avium- complex, Mycobacterium tuberculosis, Bartonella henselae, Nocardia asteroides, Actinomyces israelii |
Protozoa | Cryptosporidia, Leishmania donovani, Pneumocystis carinii |
Tumors | Non-Hodgkin’s lymphoma, Kaposi sarcoma, cancer (squamous cell and adenocarcinoma), lymphoma |
Pill-induced | Zalcitabine, zidovudine, other |
Gastroesophageal disease, idiopathic | Idiopathic esophageal ulcer |
AIDS, Acquired immune deficiency syndrome.