Introduction: Esophageal intramural pseudodiverticulosis (EIP) is a benign condition that presents as dysphagia in greater then 80% of patients. The condition is rare and pathogenesis is believed to be due to an obstruction of excretory ducts or motor disorders of the esophageal wall, each of which can lead to ductal dilation. We describe an interesting case of an HIV patient with complaints of dysphagia found to have EIP. The association of EIP with HIV is rare and has only been reported on a few occasions, but is a logical one given the propensity of HIV patients to develop esophageal Candidiasis, and the association of this fungal infection with the development of pseudodiverticula. Our patient, a 38-yearold male with HIV, presented with complaints of chest and abdominal pain. He had been experiencing progressive epigastric pain for the preceding 2 weeks described as burning, sharp, and without radiation. There was associated dysphagia to solid food, which was often followed by vomiting. Initial investigation with esophagram showed what were described as massive esophageal ulcers with fistulous communications and numerous pseudodiverticula. Upper endoscopy demonstrated multiple pseudodiverticula without any other gross abnormalities. Pathology from biopsies showed chronic inflammatory changes consistent with pseudodiverticula formation, but no evidence of infection. On repeat questioning the patient reported multiple episodes of Candidiasis in the past. Esophageal intramural pseudodiverticulosis presents as multiple flask-shaped dilations in the wall of the esophagus usually on esophogram or CT as visualization of EIP by EGD only occurs in about 20% of cases. Chronic alcoholism, diabetes mellitus, esophageal Candidiasis, and reflux disease are often reported in association with EIP, however an association with HIV has only been described a few times in the literature. We believe that difficulty visualizing pseudodiverticula on EGD and their resolution with treatment of the inciting pathology has led to underreporting of this association in the past. The extent of the tract formation seen in our patient was also very unique, as the outpouchings have generally been reported on the order of millimeters and not centimeters as seen in our case.Figure 1: Pseudodiverticulum of the middle third of the esophagus.