Delayed development of tuberculous bronchoesophageal fistulas in a patient with AIDS necessitates endoscopic surgery

Gastrointestinal CMV Disease and Tuberculosis in an AIDS Patient: Synergistic Interaction between Opportunistic Coinfections

The AIDS pandemic has made diseases such as tuberculosis, CMV disease, and other opportunistic infections more prevalent; these diseases may even be found to be associated among themselves, and the natural history of each disease may present in an unusual manner. We report the case of a 41-year-old man with HIV (CD4 of 144 cells/dL) and HCV with hematochezia due to tuberculosis in the ileocecal valve and descending colon and CMV tissue invasive disease in the esophagus and descending colon. Coinfection among tuberculosis and cytomegalovirus in the gastrointestinal tract was described only once in a patient with a recent diagnosis of HIV that affected the distal ileum and ascending colon. We will discuss the peculiarities of the case and the behavior of the immune system in the face of simultaneous opportunistic infections. This is a challenging scenario that has scarce publications and is of great clinical importance.

Oesophagobronchial fistula caused by varicella zoster virus in a patient with AIDS: a unique case

Human herpesvirus oesophagitis in human immunodeficiency virus positive patients is caused by cytomegalovirus and herpes simplex virus; no cases of oesophagitis and oesophagobrochial fistula as a result of varicella zoster virus (VZV) have been reported to date. This report describes the case of a patient with a 2-3 mm deep oesophageal ulcer whose viral culture was positive for VZV. The patient was treated with acyclovir with resolution of the symptomatology. After the end of the induction treatment, because of the onset of fever and fits of coughing during eating, the patient underwent oesophagography, which showed an ulcer with an oesophagobronchial fistula in the middle and lower third of the oesophagus. This case report stresses the role of VZV infection as a possible cause of oesophagobronchial fistula, a rare but benign condition in patients with AIDS.

Esophageal strictures complicating ulcerative esophagitis in patients with AIDS

OBJECTIVE

Esophageal strictures have been reported to complicate opportunistic esophageal infections in human immunodeficiency virus (HIV)-infected patients, although the etiology, prevalence, and incidence of strictures after these infections have not been studied.

METHODS

HIV-infected patients undergoing upper endoscopy for clinical indications over a 7.5-yr period were prospectively identified. The cause of esophageal ulceration was defined by previously proposed criteria. Endoscopic re-examination was performed in most patients after treatment, and long term clinical follow-up was obtained. An esophageal stricture was defined as circumferential luminal narrowing of > or = 30% at endoscopy and/or barium esophagography.

RESULTS

A total of 160 HIV-infected patients were identified with esophageal ulcer. Of these patients, 13 (8%; 95% CI 4-12%) developed esophageal strictures. Strictures were identified at the time of initial endoscopy in three patients (cytomegalovirus [CMV] in one patient and gastroesophageal reflux disease in two), and at the site of ulcer healing or persistence in the other patients (four, CMV; four, idiopathic; one, herpes simplex virus [HSV]; one, CMV/HSV). Long term follow-up did not identify any additional patients who developed an esophageal stricture.

CONCLUSION

Esophageal strictures infrequently complicate ulcerative esophagitis caused by opportunistic infections in HIV-infected patients.