Giant Esophageal Ulcers

Raymond A. Rubin, M.D., and Marc S. Levine, M.D.

N Engl J Med 1996; 334:1029April 18, 1996

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Figure 1 Acute, severe odynophagia developed in a 52-year-old man known to be positive for the human immunodeficiency virus (HIV). A double-contrast esophagogram (Panel A) shows two giant, ovoid ulcers (arrows) measuring 3 cm and 6 cm in length in the middle and distal thirds of the esophagus, respectively. An endoscopic photograph of the mid-portion of the esophagus (Panel B) shows the proximal ulcer to be a deep lesion with well-demarcated margins (arrows). The distal ulcer had a similar appearance, and the mucosa between the lesions was grossly normal, without exudates or plaques. Endoscopic brushings, biopsy specimens, and cultures obtained from the ulcer margins and ulcer beds were negative for cytomegalovirus, so the patient was assumed to have HIV esophagitis. His symptoms resolved in less than two weeks with 40 mg of prednisone daily.

Kim Eagle, M.D.

Raymond A. Rubin, M.D.
Thomas Jefferson University Hospital, Philadelphia, PA 19107

Marc S. Levine, M.D.
Hospital of the University of Pennsylvania, Philadelphia, PA 19104

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