As a physician who has cared for a patient with human immunodeficiency virus (HIV) infection and esophageal cancer, I read the description of 19 other cases by Stebbing and colleagues1 with interest. I would like to briefly present my case and suggest a factor that may be implicated.
In 2002, a 47-year-old woman was admitted to Johns Hopkins Bayview Medical Center, Baltimore, Maryland, with difficulty swallowing solid food and melena. She was diagnosed as having HIV infection 4 years prior to this, and she likely acquired HIV through sexual transmission from her husband. She smoked cigarettes but did not drink alcohol and had no history of gastroesophageal reflux disease. Her most recent CD4 lymphocyte count was 654/μL (to convert to ×109/L, multiply by 0.001), and she had never received antiretroviral therapy. On upper endoscopy, she was found to have a 5-cm diameter mass in the distal esophagus; the gastroesophageal junction appeared normal. Biopsy results showed an infiltrating moderately differentiated squamous cell carcinoma. She received chemotherapy but subsequently died from septic shock 3 months after this diagnosis was made.