Fistulous degeneration of a giant esophageal ulcer in a patient with acquired immune deficiency syndrome.

Esophageal involvement in human immunodeficiency virus (HIV) disease can take many forms, including the recently described giant solitary ulcerations thought to be due to cytomegalovirus or, more recently, Mycobacterium species. Current experience suggests that steroids may provide symptom relief and healing in selected patients. We report a case of fistulous change in one such ulcer, with documented endoscopic, radiologic, and pathologic findings. No organism was identified by culture or pathologic staining, leading to a postulated role for the persistent irritation of medications.