Esophageal Candidiasis in the Diagnosis of HIV-Infected Patients

To the Editor. —In the recently revised definition of acquired immunodeficiency syndrome (AIDS), esophageal candidiasis remains as a diagnostic criterion for AIDS. 1 Nevertheless, Clotet et al 2 have reported a group of patients with asymptomatic esophageal candidiasis without the development of other opportunistic infections or neoplasms during a follow-up period of 14 months. We have recently observed a case of esophageal candidiasis that shows that it can occur before the development of AIDS as defined by the Centers for Disease Control. To our knowledge, this is a previously unreported feature: the appearance of oral and esophageal candidiasis during an acute episode of primary human immunodeficiency virus (HIV) infection. Report of a Case. —A 29-year-old heroin abuser presented with a seven-day history of a "mononucleosis-like" syndrome and an 8-kg weight loss. On physical examination he looked ill, with a temperature of 37.7°C. He had oral thrush, axillar adenopathy, and a