VALUE OF LABORATORY INVESTIGATIONS IN CLINICAL SUSPICION OF CYTOMEGALOVIRUS-INDUCED UPPER GASTROINTESTINAL-TRACT ULCERATIONS IN HIV-INFECTED PATIENTS

To assess the value of laboratory investigations for the diagnosis and treatment of cytomegalovirus-induced upper gastrointestinal tract ulc erations, the medical records and biopsy material from HIV-infected pa tients were reviewed retrospectively during a 12-month period. Clinica l diagnosis of cytomegalovirus (CMV) ulceration, based on characterist ic endoscopic appearance of extensive ulceration of the mid- to distal esophageal or gastric mucosa and responsiveness to anti-CMV therapy, was compared with laboratory investigations of biopsies. Laboratory pr ocedures consisted of both histopathological examination of the biopsy specimens and viral culture. Twenty episodes in 12 HIV-infected patie nts could be evaluated. Clinical diagnosis of CMV ulceration appeared to be justified in 14 of 20 episodes (70%), which were confirmed by la boratory investigations. Of the remaining six episodes, which showed p artial or no response to anti-CMV therapy, laboratory investigations w ere negative in two episodes and discrepant in four episodes (histopat hology or viral culture positive). A good response to anti-CMV therapy was more frequent in patients whose biopsies proved positive by histo pathological examination and/or viral culture than in patients with ne gative tests (82% versus 0%), which indicates the importance of both i nvestigations. In conclusion, laboratory diagnosis of CMV-induced uppe r gastrointestinal tract ulcerations supported the diagnosis and decis ions on treatment of CMV-induced upper gastrointestinal tract ulcerati ons. (C) 1996 Wiley-Liss, Inc.