Giant esophageal ulcer associated with cytomegalovirus.

A young, former homosexual, and narcotics-abusing male patient developed malaise, fever, lymphadenopathy, esophageal candidiasis, lymphopenia, and anergy progressing to severe odynophagia and a weight loss of 60 lb. Repeated endoscopic examinations revealed a progressively enlarging giant esophageal ulcer. Rigid endoscopic biopsy specimens and autopsy specimens demonstrated innumerable typical cytomegalovirus inclusions in the esophageal ulcer and no invasive candidiasis. Inclusions were also demonstrated in clinically silent smaller ulcers of the terminal ileum, colon, and adrenals. This case illustrates a further gastrointestinal manifestation of cytomegalovirus disease.