P3950 - Actinomycosis Esophageal Ulcer in an AIDS patient

Vedika Rajasekaran, MD, Lucas Hopkins, MD
Wellstar Kennestone, Marietta, GA

Introduction: Esophageal Actinomycosis (EA) is a rare etiology of esophageal infections found in immunocompromised patients. Only 24 reports cases have been recorded previously. The most common presenting symptoms are dysphagia and odynophagia. Definitive diagnosis can be made via esophageal biopsy of lesions but can also be challenging since isolation of this bacteria only occurs in small number of cases. We present a rare care of actinomyces esophageal ulcer in a patient with AIDS.

Case Description/Methods: 51 yo F with AID’s on Biktarvy (CD4 < 20), and history of candida esophagitis presented with persistent abdominal pain and odynophagia. She was previously diagnosed with HIV and candida esophagitis 4 months prior. She was found to have neutropenic fever this visit. CT chest showed mild to distal esophageal wall thickening. EGD showed large necrotic ulcer with yellow fatty base in esophagus. Esophageal biopsy revealed inflamed reactive squamous mucosa with filamentous organisms most reminiscent of actinomyces. Workup for other infectious cause of esophagitis was equivocal.

Discussion: The common causes of infectious esophagitis are Candida, HSV, CMV, and HIV. However esophageal actinomycosis is another rare but important etiology of infectious esophagitis in an immunocompromised individual. Actinomyces usually occurs when there is an insult to the native skin. In our patient, a possible cause could be a prior EGD a few months earlier. Treatment usually involves 4-6 weeks of IV penicillin, followed by oral penicillin or amoxicillin for 6-12 months based on positive therapeutic outcomes. In our patient, she was found to have Mycobacterium avium complex (MAC) so was treated with 12 months of Augmentin, Azithromycin, and Ethambutol.


Disclosures:


Vedika Rajasekaran, MD, Lucas Hopkins, MD. P3950 - Actinomycosis Esophageal Ulcer in an AIDS patient, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.