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.