Purpose: To determine the causes of giant esophageal ulcers in patients with human immunodeficiency virus (HIV) and whether clinical or radiographic criteria can be used to differentiate the infections that cause these ulcers.
Materials and methods: From January 1990 through December 1993, giant esophageal ulcers ( > or = 1 cm in diameter) were found in 21 HIV-positive patients (19 men and two women 23-66 years of age; mean, 39 years). The radiographic findings were reviewed and correlated with clinical, endoscopic, and pathologic findings.
Results: In 16 patients, the ulcers were caused by HIV, in three by cytomegalovirus (CMV), and in two by CMV and HIV. The clinical and radiographic findings were the same for the two types of ulcers. However, HIV ulcers responded to treatment with steroids, and CMV ulcers responded to treatment with ganciclovir.
Conclusion: It is not possible to differentiate HIV from CMV ulcers on the basis of clinical or radiographic criteria; thus, endoscopy is necessary for a definitive diagnosis.