Thalidomide as Adjunctive Therapy in a Case of HIV-Associated Idiopathic Esophageal Ulcer
DOI:
https://doi.org/10.66004/2764-734X.e20260675Keywords:
AIDS-Related Opportunistic Infections, Esophageal Diseases, Thalidomide, Case ReportAbstract
HIV-associated idiopathic esophageal ulcer is a rare manifestation of advanced immunosuppression with no well-established therapeutic management. We report the case of a 19-year-old female patient presenting with epigastric pain, odynophagia, and weight loss, whose endoscopy identified an extensive ulcer in the distal esophagus. The biopsy of this lesion was nonspecific, and serological testing revealed HIV infection. The blood CD4 cell count was 5 cells/µL, and antiretroviral therapy was promptly initiated. A second endoscopy revealed worsening of the inflammatory process and the esophageal ulcer; despite the lack of an etiological diagnosis, empirical treatment with ganciclovir was chosen, which was later switched to foscarnet. The absence of clinical improvement even after two weeks of treatment prompted a new examination, whose endoscopic findings showed an even more pronounced worsening of the lesion, with equally inconclusive biopsies. Thus, a diagnosis of HIV-associated idiopathic ulcer (potentially aggravated by a possible immune reconstitution inflammatory syndrome) was considered, and the introduction of thalidomide at 100 mg/day was decided. After four weeks, there was clinical resolution and complete endoscopic healing, confirming the immunomodulatory and anti-inflammatory role of thalidomide as a potential adjunctive therapy in this type of scenario without proven causality.
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