GIANT ULCERS OF THE ESOPHAGUS IN PATIENTS WITH HUMAN-IMMUNODEFICIENCY-VIRUS - CLINICAL, RADIOGRAPHIC, AND PATHOLOGICAL FINDINGS

PURPOSE: To determine the causes of giant esophageal ulcers in patient s with human immunodeficiency virus (HIV) and whether clinical or radi ographic criteria can be used to differentiate the infections that cau se these ulcers. MATERIALS AND METHODS: From January 1990 through Dece mber 1993, giant esophageal ulcers (greater than or equal to 1 cm in d iameter) were found in 21 HIV-positive patients (19 men and two women 23-66 years of age; mean, 39 years). The radiographic findings were re viewed and correlated with clinical, endoscopic, and pathologic findin gs. RESULTS: In 16 patients, the ulcers were caused by HIV, in three b y cytomegalovirus (CMV), and in two by CMV and HIV. The clinical and r adiographic findings were the same for the two types of ulcers. Howeve r, HIV ulcers responded to treatment with steroids, and CMV ulcers res ponded to treatment with ganciclovir. CONCLUSION: It is not possible t o differentiate HIV from CMV ulcers on the basis of clinical or radiog raphic criteria; endoscopy is necessary for a definitive diagnosis.