Esophageal Ulcer Caused by Cytomegalovirus: Resolution during Combination Antiretroviral Therapy for Acquired Immunodeficiency Syndrome

Department of Medicine, University of Alabama at Birmingham, 35294-0007, USA.
Southern Medical Journal (Impact Factor: 0.93). 09/2000; 93(8):818-20.
Source: PubMed


A 36-year-old man with a 5-year history of untreated human immunodeficiency virus (HIV) infection had odynophagia for 14 days. Fifteen days earlier, he had begun taking trimethoprim-sulphamethoxazole and combination antiretroviral therapy that included lamivudine, zidovudine, and nelfinavir. He had no history of opportunistic infection. The CD4 lymphocyte count was 67/microL and HIV-RNA level was 359,396 copies/mL. Esophagogastroduodenoscopy revealed a large, well-circumscribed esophageal ulceration 31 cm from the incisors. Histopathologic examination of esophageal biopsy specimens showed cytopathic changes diagnostic of cytomegalovirus (CMV). In situ DNA hybridization was positive for CMV. While combination antiretroviral therapy was continued, the esophageal symptoms resolved within 4 days of endoscopy without specific therapy for CMV. Follow-up endoscopy 4 weeks later revealed a normal-appearing esophagus, and the patient has remained symptom-free for 10 months.

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    • "The major reason for this finding may well be the immunodeficiency due to dysfunction of T-cell-response in the patients after several years. Monkemuller and Wilcox (2000) reported a case of CMV esophagitis in a patient with AIDS that improved by treatment with antiretroviral therapy alone without anti CMV therapy. After bone marrow transplantation, Zaia (2002) states among other risk factors for CMV disease the failure of lymphoid reconstitution post transplantation. "
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    • "Usually, resolution of symptoms and endoscopic findings is obtained with IV ganciclovir or foscarnet. Combined antiretroviral therapies may also be effective, even without specific treatment of CMV [21]. However, in the case of perforation, despite immediate surgical resection and antiviral therapy, mortality rate remains elevated (> 80%), due to elevated operative mortality and increased postoperative complications [17,18]. "
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