Causes of Esophageal Ulcers in HIV

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

VirusesCytomegalovirus, herpes simplex virus type II, Epstein-Barr virus, papovavirus, human herpes virus-6
FungiCandida spp., Histoplasma capsulatum, Cryptococcus neoformans, mucormycosis, aspergillosis, Penicillium chrysogenum, Exophiala jeanselmei
BacteriaMycobacterium avium- complex, Mycobacterium tuberculosis, Bartonella henselae, Nocardia asteroides, Actinomyces israelii
ProtozoaCryptosporidia, Leishmania donovani, Pneumocystis carinii
TumorsNon-Hodgkin’s lymphoma, Kaposi sarcoma, cancer (squamous cell and adenocarcinoma), lymphoma
Pill-inducedZalcitabine, zidovudine, other
Gastroesophageal disease, idiopathicIdiopathic esophageal ulcer

AIDS, Acquired immune deficiency syndrome.

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