ESOPHAGEAL ULCERATION RELATED TO ZALCITABINE (DDC)

Zalcitabine (dideoxycytidine, ddC) is an antiretroviral agent currently being evaluated for thc management of human immunodeficiency virus (HIV) infection. We report a case of recurrent esophageal ulceration in a patient taking zalcitabine while enrolled in a randomized, double blind study of zalcitabine compared with zidovudine. The patient had recurrent episodes of esophageal symptoms that were temporally related to the ingestion of zalcitabine. Serial esophagrams and endoscopy revealed midesophageal ulcerations; cultures were negative, and a biopsy was consistent with nonspecific inflammation. Symptoms resolved completely after the withdrawal of zalcitabine. The exclusion of other possible causes and the recurring temporal relationship between zalcitabine ingestion and esophageal symptoms imply a probable causal relationship in this patient. The potential role of zalcitabine in the management of HIV infection makes it important to understand its adverse effects in this patient population.