Background and Aims. Tissue-invasive gastrointestinal cytomegalovirus (TI-GI CMV) disease is common in immunocompromised patients, but the increasing prevalence in immunocompetent patients has been reported. This study compared the clinical manifestations, endoscopic features, treatment outcomes, and predictors for inhospital mortality of TI-GI CMV between immunocompromised and immunocompetent patients. Methods. Patients with HIV infection, malignancy, or receiving immunosuppressive agents (chemotherapy, high dose, or long-term corticosteroids) were defined as the immunocompromised group. Demographic and inhospital mortality data were obtained and retrospectively analyzed. Results. A total of 213 patients (89 immunocompetent) with histologically confirmed TI-GI CMV were enrolled. Immunocompetent patients were older (70 vs. 52 years; p < 0.001 ), had more GI bleeding as a presenting symptom (47.2% vs. 29.0%; p = 0.010 ), and shorter symptom onset (2 vs. 14 days, p = 0.018 ). Concomitant extra-GI involvement was only seen in the immunocompromised group (6.5% vs. 0%; p = 0.02 ). Diffuse GI tract (14.5% vs. 4.5%; p = 0.032 ) and esophageal involvement (14.5% vs. 5.6%; p = 0.046 ) were more frequent in the immunocompromised, while small bowel involvement was more frequent in the immunocompetent group (19.1% vs. 8.1%; p = 0.029 ). An overall inhospital mortality was 27.7%. There was no significant difference in inhospital survival probability between the two groups (Peto-Peto test, p = 0.65 ). ICU admission (hazard ratio [HR] 7.21; 95% CI 2.55-20.36), sepsis or shock (HR 1.98; 95% CI 1.08-3.66), malnutrition (HR 2.62; 95% CI 1.05-7.01), and receiving chemotherapy (HR 5.2; 95% CI 1.89-14.29) were independent factors for inhospital mortality. Antiviral treatment for more than 14 days was the only protective factor to improve survival (Peto-Peto test, p < 0.001 ). Conclusions. Immunocompetent and immunocompromised patients with TI-GI CMV disease had distinct clinical and endoscopic characteristics. There was no significant difference in the inhospital mortality between the two groups. The factors for mortality were ICU admission, sepsis/shock, malnutrition, and receiving chemotherapy. Early diagnosis and initiation of antiviral treatment might improve the survival probability.

Esophageal leiomyoma is uncommon. However, this tumor is the most common subepithelial tumor affecting the esophagus, comprising approximately two-thirds of benign esophageal tumors. Leiomyomas of the esophagus rarely cause symptoms when they are single and &#x3c;5 cm. The mainstay of treatment is esophagectomy for symptomatic patients. A 68-year-old male patient presented with progressive dysphagia for 4 months. The degree of dysphagia and chest discomfort was more severe on solid rather than liquid diet. The CT scan of the chest showed multiple well-defined, submucosal nodules, up to 1.9 cm in diameter located at the middle esophagus. The barium swallow study illustrated multiple, well-defined, smooth, semilunar filling defects along the mid to distal esophagus. Meanwhile, esophagogastroduodenoscopy revealed 8 smooth subepithelial masses. Moreover, the radial EUS showed multiple hypoechoic masses arising from the 4th layer, with some of the tumors connected to others as a horseshoe-like shape causing narrowed lumen. Last, high-resolution esophageal manometry revealed ineffective esophageal motility. We report a rare case of numerous esophageal leiomyomas which caused dysphagia as a result of both mechanical obstruction and hypomotility disorder. The histopathology confirmed the diagnosis of esophageal leiomyoma. Symptoms improved significantly after lifestyle modifications and adherence to dietary advice on the part of the patient.

<p><strong>Objective</strong>. The aim of this case report is to illustrate a very rare case of emphysematous pyelonephritis complicated by IgAdominant postinfectious glomerulonephritis.</p><p><strong>Case Report</strong>. We report the case of a 53-year-old woman with emphysematous pyelonephritis who initially presented with unintentional weight loss for 3 months and subnephrotic range proteinuria without fever. Urinalysis revealed proteinuria, microscopic hematuria, and pyuria. A kidney biopsy was performed for suspected glomerulonephritis. The patient’s right kidney biopsy was consistent with immunoglobulin A (IgA)-dominant infection-related glomerulonephritis. Abdominal computed tomography to seek the possible source of infection revealed staghorn stones obstructing dilated calyces and gas collection within the collecting system. The final diagnosis was emphysematous pyelonephritis of the left kidney complicated by IgA-dominant infection-related glomerulonephritis of the right kidney.</p><p><strong>Conclusion</strong>. We present an atypical presentation of emphysematous pyelonephritis in terms of clinical presentation (prolonged course of illness without fever) and its complications (IgA-dominant infection-related glomerulonephritis). This case study highlights the critical role of kidney biopsy in the diagnosis and the diverse clinical manifestations in clinical medicine.</p><p><br /><br /></p>

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