Idiopathic esophageal ulceration in the acquired immunodeficiency syndrome: Radiologic reappraisal in 10 patients

Idiopathic esophageal ulceration in patients with AIDS has previously been described. Establishing this diagnosis is important because of the excellent response of these ulcers to corticosteroid therapy. We studied 10 such patients with esophagography and endoscopy. HIV was isolated from the ulcer base in six of the 10 patients utilizing various techniques including in situ hybridization. No other organisms were found. All of the ulcers were in the distal half of the esophagus and were solitary in eight of the 10 patients. The solitary ulcers were large (2.5×2.0 cm to 12×9 cm) and deep (>0.5 cm) with undermined margins. In three patients, fistulae arose from the distal esophagus and crossed the gastroesophageal junction. In one patient, a huge idiopathic ulcer perforated into the mediastinum. These latter findings are not seen in the more common ulcerating AIDS esophagitides due to herpes simplex and cytomegalovirus.