Cytomegalovirus Esophagitis and Colitis, Esophageal Candidasis and Colon Amebiasis in an HIV Patient with More than 200/.MU.l CD4-positive T Lymphocytes

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Case: A 24-year-old Japanese man with HIV infection (a man who has sex with men) was referred to our hospital because of diarrhea, abdominal pain and high-grade fever. Endoscopic examination revealed colon and esophageal ulcers, which were histologically found to be caused by cytomegalovirus (CMV) infection. Esophageal candidasis and amebic colitis were concurrent with CMV infection. CMV pp65 antigenemia value was 18 positive cells per 50, 000 cells. At the time of the CMV diagnosis, a CD4-positive (CD4) T lymphocyte count was 259/μl. Fever and diarrhea gradually improved after treatment with ganciclovir and foscarnet for CMV infection and metronidazole for amebiasis followed by anti-retroviral therapy. Discussion: The risk of opportunistic infections in patients with HIV has long been known to depend on the degree of immunodeficiency as measured by CD4+T cells. In the antiretroviral-naive patient, CMV infection usually occurs only when CD4 T cells are less than 100/μl. However, our case demonstrates that even at a higher CD4 T cell count, the complication of CMV infection may occur in HIV infection.
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