Idiopathic Esophageal Ulcers in AIDS Completely Healed With Highly Active Anti-Retroviral Therapy

A 51-year-old white man presented to the emergency department with a 3-month history of atypical chest pain, odynophagia to solids and liquids, and a 18-kg weight loss. He was febrile to 39oC and tachycardic. Physical exam was remarkable for bilateral submandibular lymphadenopathy and thrush in the posterior oropharynx. He was diagnosed with AIDS with CD4 count 146 cells/mm3 and viral load 423,000 copies/mL. Esophagogastroduodenoscopy (EGD) showed a large, deep, irregular esophageal ulcer (Figure 1). Biopsies of the ulcer margins and bases were negative for malignancy or infection. He was diagnosed with an idiopathic esophageal ulcer (IEU) secondary to AIDS. He was started on a proton pump inhibitor and highly active anti-retroviral therapy (HAART). Three weeks later, repeat EGD revealed complete resolution of the esophageal ulcer (Figure 2). More than 1 year after diagnosis, he continued to do well with a viral load of 53, CD4 count of 708, and without any recurrence of odynophagia.