Antiretroviral therapy alone resulted in successful resolution of large idiopathic esophageal ulcers in a patient with acute retroviral syndrome.

摘要

Esophageal ulceration is a well known complication of end-stage HIV infection, and also patients with acute retroviral syndrome [1-5]. Various infectious agents can cause esophageal diseases, including Candida species, cytomegalovirus (CMV), and herpes simplex virus (HSV). However, in a large proportion of patients with esophageal ulcers, no agent can be identified and ulceration is considered idiopathic [1,2]. Here, we report a case of an idiopathic esophageal ulcer with concomitant primary HIV-1 infection. A previously healthy 36-year-old Japanese male homosexual presented with odynophagia, fever, and headache. Five days after the onset, he was diagnosed with oral candidiasis and treated with fluconazole for 5 days. Despite the treatment, odynophagia did not improve. The result of voluntary HIV screening 1 month before the onset of the symptoms was negative. However, 8 days after the initial presentation, ELISA for anti-HIV antibody was positive. The patient was referred to our hospital 2 weeks after the onset of odynophagia.