Images in Clinical Medicine
Cytomegalovirus Esophageal Ulcers
N Engl J Med 2000; 342:475February 17, 2000
- Article
Figure 1 A 48-year-old man infected with the human immunodeficiency virus had had recurrent painful ulcers in his mouth and esophagus for several years. Biopsies of the lesions were nondiagnostic. Odynophagia and substernal chest pain responded to repeated courses of prednisone for presumed idiopathic esophageal ulcers. A subsequent recurrence led to a weight loss of 14 kg. The CD4+ cell count was 9 per cubic millimeter. Esophagoscopy revealed extremely large coalescing ulcers of the distal esophagus, effectively resulting in a “double-barreled” lumen (Panel A), as well as evidence of Barrett's esophagus. A barium swallow (Panel B) confirmed the presence of at least four distal esophageal ulcers and revealed spontaneous reflux of gastric contents into the true lumen (arrowheads in Panels A and B) and false lumen (arrows in Panels A and B) of the esophagus. Biopsies of the ulcers showed viral cytopathic effects, and cultures were positive for cytomegalovirus. After six weeks of intravenous ganciclovir and oral omeprazole therapy, the patient had regained 6 kg and had no odynophagia or chest pain. Repeated esophagoscopy revealed less active, shallower areas of ulceration, but the overall anatomy remained grossly abnormal.
J. Michael Kilby, M.D.
Swarnjit Singh, M.D.
University of Alabama at Birmingham, Birmingham, AL 35294-2050
