A 38-year-old male presented with dysphagia for two months.
A gastroscopy showed a large deep ulcer in the distal esophagus biopsied at its bottom and edges.
Histological study showed granulation tissue and necrotic material herpes zooid with no evidence of malignancy and no intranuclear or intracytoplasmic inclusions by cytomegalovirus (CMV) viruses.
At two weeks a second gastroscopy confirmed the persistence of the lesion, and immunohistochemical study and polymerase chain reaction (PCR) for CMV-DNA and HSV-DNA were negative in the new biopsies.
Blood serology for these viruses ruled out an acute infection (IgM negative immunoglobulin).
The homosexuality condition of the patient led us to investigate the human acquired immunodeficiency virus (HIV), with a positive result in two determinations (immunoquimodality).
The study of lymphocyte populations was: CD4 (9% of the total).
The patient started treatment with darunavir 800 mg and ritonavir 100 mg. After one month of antiretroviral treatment an improvement in CD4 lymphocyte count was confirmed and a new gastroscopy showed the disappearance of the esophageal ulcer.
