A 47 year old AAM with a history of HIV with an AIDS defining CD4 count of 50 presented to the hospital with a 3 week history of odynophagia to both liquids and solids. The patients odynophagia was associated with left sided chest pain and dysphagia to solids particularly medications.
An EGD was performed to further evaluate these symptoms. Upon entering the distal esophagus a pseudodiverticulum was noted. There was an active ulcer base seen within the pseudodiverticulum. There were also two possible fistulas noted.
These findings were located near the GE Junction, just proximal to the Z-line; this is a common location where idiopathic HIV ulcers can be found.
Biopsies were obtained from the area of active ulceration. Histopathological evaluation revealed hyperplastic squamous mucosa. There was also evidence of acute and chronic inflammation. There was no evidence of viral associated cytopathological changes. Special PAS stain, with digestion, was negative candidal species.
In order to further evaluate the possible fistulous connections a barium esophogram was preformed. The area of ulceration was noted in the distal esophagus, however there was no evidence of any fistulous connections.
This patient had undergone multiple previous endoscopies to evaluate similar complaints.
Each endoscopy revealed single or multiple ulcerations in the distal esophagus. Biopsies from these ulcerations consistently were negative for viral cytopathological changes or fungal elements. The end results of these multiple and frequent ulcerations was the development of the pseudodiverticulum noted on his current endoscopy.
The differential diagnosis for odynophagia in HIV patients with AIDS include:
? Esophageal Candidiasis
? Herpes Simplex Virus
? Mycobactrium Tuberculosis
? Idiopathic HIV Ulcer
J. Royce Groce, M.D., University of Texas Medical Branch
Eduardo J. Eyzaguirre, M.D., University of Texas Medical Branch
Gottumukkala S. Raju, MD, MD Anderson Cancer Center