AIDS patients have been seen with a variety of ulcerating esophageal lesions, which may be refractory to both diagnostic approaches and empiric medical intervention. There are reports of these ulcers eroding vessels and severely limiting oral nutrition. After the report of success with prednisone therapy for oral and hypopharyngeal ulcers in AIDS patients, we attempted similar treatment of an AIDS patient with a refractory giant esophageal ulcer. The patient responded promptly to this therapy. To our knowledge this is the first report of successful prednisone therapy for giant esophageal ulcer in an AIDS patient.