Correspondence

Esophageal Actinomycosis

Authors: Ashoni K. Arora, MD, Jill Nord, MD, O. Olofinlade, MD, Bruce Javors, MD

Abstract

To the Editor:


A 37-year-old African American bisexual man with acquired immunodeficiency syndrome (AIDS) presented with recurrent chest pain. His CD4 cell count was 4/mm3 and viral load was 19,000 copies/mm3. An esophageal biopsy performed 2 months previously had revealed extensive candidal infection with ulceration. He had a temporary response to treatment with fluconazole. Biopsy was repeated at the time of presentation and revealed Actinomycesspecies with distinct sulfur granules and continued candidal infection. Barium esophagram showed thickened mucosa with a few short sinus tracts. Concurrent computed tomography showed an area of low attenuation measuring 2.0 × 1.3 × 1.4 cm in the wall of the distal esophagus, consistent with necrosis or abscess. No sinus tracts or fistulae were seen.

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