A clinical syndrome of large ulcerations of the oesophagus had been well described in the literature in HIV-infected patients. These patients are markedly symptomatic with odynophagia and substernal chest pain as their most common presenting symptoms. Weight loss often accompanies this disorder. Despite biopsy evaluation for patients with idiopathic oesophageal ulcerations, no identifiable cause of this lesion is found. Although some authors suggest that these ulcerations represent a primary HIV infection of the oesophagus, other question the role of HIV itself in the development of these lesions. Patients with this disorder appear to respond to corticosteroid therapy in the oral, intravenous or intralesional form. This therapy could possibly predispose to infectious complications. Acute HIV infection has also been described presenting with lesions of the oesophagus which may be single or multiple. It has again been suggested that HIV is the primary aetiology of the oesophageal ulcerations. Endoscopic evaluation is mandatory for the diagnosis of idiopathic oesophageal ulcerations of the oesophagus in HIV-infected patients. It is important to rule out the many other causes of oesophageal ulcerations in these patients, as treatment modalities are determined by proper diagnosis of the underlying disorder.