3111 Achalasia in a Patient Newly Diagnosed With HIV

Abstract

INTRODUCTION: Esophageal disease is common during HIV/AIDS infection and varies from esophagitis due to opportunistic infections as candida, cytomegalovirus and herpes simplex, to idiopathic ulcerations and non-specific motility disorders, but it has been suggested also that HIV infection itself can be the culprit of esophageal symptoms. We are presenting a case report of likely achalasia that was discovered in a patient newly diagnosed with HIV-1. CASE DESCRIPTION/METHODS: A 46-years-old male with no significant past medical history presented with 1 month history of recurrent attacks of nausea and non-bilious, non-projectile vomiting, 30-60 minutes following meals associated with anorexia, dysphagia and non-intentional weight loss of 10 lb. He did not have any fever, abdominal pain, diarrhea, constipation, hematemesis or melena. He was in a heterosexual relationship with no known contact to HIV infected patients. Examination was not evident of abdominal tenderness or any body swellings. Labs showed normocytic anemia with hemoglobin of 11.8 g/dl in addition to positive HIV-1 serology with viral load of 151,000 and CD4 count of 153. CT Chest was done showing sub-stantial dilation of the lower cervical, mid and distal esophagus with solid and gaseous contents. After 24 hours of “Nothing by mouth,” upper endoscopy was performed showing markedly dilated esophagus with esophageal mucosa covered with adherent food and secretions in addition to LA grade C esophagitis in the distal esophagus. Esophageal biopsy showed candida esophagitis with negative immunostains for CMV and HSV. He was started on HAART therapy and is awaiting manometry for confirmation of Achalasia diagnosis. DISCUSSION: It is accepted that HIV is aneuropathic virus and it has been related to loss of autonomic nerves in different parts of the body. Motor abnormalities have been identified in the esophagus, stomach and small intestine. The case report highlight that HIV maybe considered as possible infectious cause of achalasia.