Esophageal Polyps in a HIV Infected Patient with Upper GI Bleeding

Abstract

To highlight esophageal polyps in the setting of upper GI bleeding in a HIV infected patient. Case Report: 40 y/o male was referred for follow up EGD two months after an episode of massive upper gastrointestinal bleed. Initial upper endoscopy (EGD) had revealed multiple esophageal polyps with ulcerations and the patient was subsequently placed on proton pump inhibitors. Follow up EGD revealed multiple small and large polyps in the esophagus with severe candidal esophagitis. A single large pedunculated polyp (7 cm in length) was seen in the upper esophagus that extended from 15 cm to 22 cm from the gums. Barium esophagogram also revealed the multiple esophageal polyps and the large pedunculated polyp was clearly seen in the proximal esophagus, measuring 2 cm in transverse diameter. Biopsies from the polyp showed candida esophagitis with granulation tissue and ulceration. No dysplasia or malignancy were noted. Viral cultures were negative. The patient was treated with a two week course of oral fluconazole. He was noncompliant with subsequent follow up. Two months later, HIV testing was found to be positive and his CD4 count was 6. He developed respiratory failure and died shortly afterwards at an outside instituition. Discussion: Esophageal polyps in the setting of HIV infection is seen rarely. Primary esophageal lymphomas and inflammatory fibroid polyps of the esophagus have been reported in HIV infected patients and they usually present with dysphagia. Esophageal polyps as a possible cause of upper GI bleeding, as illustrated in our case, is extremely rare. Conclusion: In patients with HIV infection, esophageal polyps should be considered in the setting of upper GI bleeding. [figure 1][figure 2]FigureFigure