Treatment of severe odynophagia with long-acting topical nitroglycerin ointment in a patient with acquired immune deficiency syndrome

Abstract

Odynophagia and dysphagia are common gastrointestinal symptoms experienced by patients with the acquired immune deficiency syndrome AIDS. These symptoms can significantly decrease food intake and thus worsen nutritional status, leading to significant morbidity in AIDS patients. Esophageal candidiasis is the most common etiological factor associated with odynophagia and dysphagia in AIDS patients, but there are other infectious and malignant causes for these symptoms. Often the standard treatments for these causes are not satisfactory. The authors report a patient with AIDS who had oral candidiasis refractory to oral ketoconazole and severe odynophagia which severely restricted his oral intake. This patient responded dramatically to long-acting nitroglycerin ointment while intravenous amphotericin B was being initiate. The authors propose that esophageal spasm may be a significant factor in the genesis of odynophagia and dysphagia in certain patients with AIDS and that smooth muscle relaxants, such as nitroglycerin or calcium channel blockers, may be important adjunctive therapies.