ACTINOMYCES INFECTION OF A CYTOMEGALOVIRUS ESOPHAGEAL ULCER IN 2 PATIENTS WITH ACQUIRED-IMMUNODEFICIENCY-SYNDROME

Esophageal disease is a significant cause of morbidity among patients with the acquired immunodeficiency syndrome (AIDS). Many organisms hav e been implicated in the pathogenesis of dysphagia and odynophagia. We describe a unique presentation of actinomyces esophageal infection in two homosexual male patients with AIDS and biopsy proven CMV esophagi tis. After failure of esophagitis to resolve with ganciclovir or fosca rnet therapy, the patients underwent repeat endoscopy and were subsequ ently found to have a secondary infection of the ulcers by Actinomyces . Treatment with intravenous penicillin G resulted in symptomatic and histopathological resolution of esophageal disease. This appears to be the first report of Actinomyces infection of esophageal ulcers in AID S patients, possibly a commonly overlooked diagnosis.