Multiple Mucosal Bridges Associated With Idiopathic Esophageal Ulcer in A Patient With HIV/AIDS

Abstract

Purpose: Idiopathic esophageal ulcerations (IEU) associated with human immunodeficiency virus (HIV) infection are now recognized as an important cause of esophageal disease in this population. It is recognized in HIV/AIDS patients with low CD4(+) lymphocyte count. It is a rare entity which mimics other causes of esophageal ulceration. IEUs are variable endoscopically in number, size and appearance. It can be associated with mucosal bridges of mid and distal esophagus. It is diagnosed when ulceration due to candida, HSV, CMV has been excluded by histo-pathology in HIV/AIDS patients. Hence endoscopy with biopsy is recommended for all HIV-infected patients with esophageal ulceration. A 48-year-old female with H/o HIV/AIDS, HTN with CD4 count of 141 cells/ul not on any antiretroviral medication presented with c/o self limited hematemesis. She was febrile, hemodynamically stable and did not c/o dysphagia or odynophagia. General and systemic physical examination was benign. Laboratory findings were as follows: Hgb: 6.5, Hct: 15.4, MCV: 89.5, Platelet: 389, BUN: 25, Creatinine: 0.8, INR: 1.07, PT: 12.4, PTT: 32.2, CD4: 141 (478-1617 cells/ul), CD8: 2181 (247- 1260 cells/ul), Help/Supp: 0.06 (0.56-4.42). Endoscopy showed 10-15mm ulcerated polypoid lesion with multiple mucosal bridges in mid- and distal esophagus. Histology failed to demonstrate any viral inclusion body or any fungal hyphae. Based on above findings, esophageal moniliasis, herpes and CMV infection of esophagus were ruled out. Hence the possible cause of mucosal bridges with esophagitis is Idiopathic Esophageal Ulcer due to HIV virus.