Cytomegalovirus esophagitis in an immunocompetent host

Venkataramani, Arjun; Schlueter, Annette J.; Spech, Thomas J.; Greenberg, E. P.

doi:10.1016/s0016-5107(94)70094-x

Cited by 17 publications

(11 citation statements)

References 4 publications

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“…A PubMed search (www.ncbi.nlm.nih.gov/PubMed) and KoreaMed search (http://www.koreamed.org/SearchBasic.php) using a combination of terms including 'cytomegalovirus/CMV' , 'esophagitis/esophageal ulcer' and 'immunocompetence/immunocompetent' yielded nine articles (7)(8)(9)(10)(11)(12)(13)(14)(15). Table 1 summarizes the clinical features of these nine cases of CMV esophagitis in immunocompetent patients and includes data from our current patient, bringing the total to 10 reported cases.…”

Section: Discussionmentioning

confidence: 99%

Cytomegalovirus esophagitis in an immunocompetent patient: Case report

Lim

Lee²,

Jin³

et al. 2014

Turk J Gastroenterol

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Cytomegalovirus (CMV) esophagitis is well-documented in immunocompromised patients. A few studies have described CMV infection in immunocompetent patients diagnosed with a critical illness. However, CMV esophagitis has rarely been documented in immunocompetent hosts. We report a case of CMV esophagitis in an immunocompetent patient who presented with chest pain and dysphagia that was successfully resolved with ganciclovir treatment. Our case supports observations that CMV esophagitis can cause significant morbidity, regardless of immune system status. Keywords: Cytomegalovirus, esophagus, immunocompetent INTRODUCTION Cytomegalovirus (CMV) is a type of herpesvirus and a common viral pathogen in humans. CMV causes various diseases, such as retinitis, hepatitis, encephalitis, pneumonia, and gastrointestinal infection in immunocompromised patients (1,2). CMV-associated gastrointestinal infection has been reported to mainly invade the colon and stomach, but it may also occur in other organs (2).CMV-associated gastrointestinal infections are generally resolved without clinical symptoms in immunocompetent patients, but the infection can be fatal in the immunocompromised (3).There is now growing evidence of CMV infection in immunocompetent patients (3-5). Here, we present a case of CMV esophagitis in an immunocompetent patient, who presented with severe progressive chest pain and dysphagia after severe post-operative ileus (POI). The patient was successfully treated with ganciclovir. This positive outcome has been added to an updated review of the literature regarding CMV esophagitis in immunocompetent hosts. CASE PRESENTATIONA 67-year-old male patient was referred to the gastroenterology department following 3 days of progressive chest pain and dysphagia. The chest pain was localized to the retrosternum and was aggravated by eating. His dysphagia was localized to the retrosternum and neck with associated odynophagia. Ten days before the attack of chest pain and dysphagia, the patient has undergone surgery for a burst fracture of the 12 th thoracic vertebra and left orbital bone fracture caused by a traffic accident. Two days after surgery, he developed abdominal distension, nausea and vomiting. He continued to vomit, and subsequently developed aspiration pneumonitis. He was managed medically for aspiration pneumonitis and POI, and his symptoms subsequently improved.At time of referral, the patient's vital signs were stable with blood pressure, 130/80 mmHg; heart rate, 72 beats/ min; respiration rate, 18/min; and body temperature, 37°C. The physical examination revealed a chronically ill-looking man with mild epigastric tenderness. The complete blood count showed leukocytes, 8,200/μL; hemoglobin, 9.8 g/dL; and platelet count, 414,000/μL. Blood chemistry showed sodium, 137 mmol/L; potassium, 3.5 mmol/L; chloride, 101 mmol/L; aspartate aminotransferase/alanine aminotransferase, 58/34 IU/L; blood urea nitrogen, 14 mg/dL; creatinine, 0.44 mg/dL; albumin, 3.1 g/dL; and C-reactive protein, 6.08 mg/dL. Case ReportTurk ...

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Section: Discussionmentioning

confidence: 99%

Cytomegalovirus esophagitis in an immunocompetent patient: Case report

Lim

Lee²,

Jin³

et al. 2014

Turk J Gastroenterol

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“…Colitis has mainly been reported, but CMV has also been implicated as a cause of symptomatic esophagitis (22), gastritis (23) and ileitis (24) in patients without underlying immunosuppression. While most cases of CMV colitis are secondary to the reactivation of latent infection in immunocompromised patients (7), CMV colitis can occur as a primary infection in immunocompetent patients.…”

Section: Discussionmentioning

confidence: 99%

Cytomegalovirus Colitis in a Critically Ill Patient Following Severe <i>Legionella</i> Pneumonia with Multiple Organ Failure

et al. 2016

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A 68-year-old man visited an emergency department complaining of dyspnea. He was diagnosed to have Legionella pneumonia with multiple organ failure. Although his multiple organ failure improved, he suffered from persistent abdominal pain and diarrhea with continuous minor bleeding. Colonoscopy revealed a longitudinal ulcer of the rectum, below the peritoneal reflection. He was diagnosed with cytomegalovirus (CMV) colitis. Antiviral therapy with ganciclovir was initiated. He finally underwent a colostomy after a bowel stricture caused an intestinal outlet obstruction, which made oral intake impossible. Based on the present case, we believe that CMV colitis must be considered as one of the differential diagnoses when critically ill patients develop continuous diarrhea and abdominal pain.

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“…GI CMV can mimic a variety of conditions including ischemic colitis, pseudomembranous colitis, inflammatory bowel disease, and even carcinoma. [11] CMV has also been implicated as a cause of esophagitis, [12] gastritis, [3] Ménétrier's disease (protein-losing hypertrophic gastropathy), [13] ileitis, [14] and colonic obstruction. [15] CMV GI disease is a serious complication in patients with AIDS.…”

Section: Discussionmentioning

confidence: 99%

Cytomegalovirus infection in gastrointestinal tract: A case series of three patients and review of literature

Ranjan

Gupta

Goyal

et al. 2015

Journal of Digestive Endoscopy

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Cytomegalovirus disease can involve any site of gastrointestinal tract from oral cavity to rectum. CMV disease most frequently occurs in patients’ with immune deficiency, such as the acquired immunodeficiency syndrome, after organ transplantation, after cancer chemotherapy and in patients on immunosuppressive medications. The number of patients with immune deficiency has increased in recent years and has lead to a substantial increase in incidence of opportunistic CMV virus. Gastrointestinal CMV infection has also been reported in immunocompetent adults. Symptoms and signs depend on part of the gastrointestinal tract involved. Diagnosis depends either on a positive mucosal biopsy or by serology, quantitative PCR or CMV antigenemia. We report three cases of CMV infection in patients with three different underlying conditions and discuss the clinical features, diagnostic approach and treatment. All patients had positive serology with high viral load on PCR. Histology with immunohistochemistry was positive for CMV in two of the three cases. Ganciclovir response was seen in all patients in respect to clinical improvement, endoscopic resolution of lesions and clearing of the virus load.

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Cytomegalovirus esophagitis in an immunocompetent host

Cited by 17 publications

References 4 publications

Cytomegalovirus esophagitis in an immunocompetent patient: Case report

Cytomegalovirus esophagitis in an immunocompetent patient: Case report

Cytomegalovirus Colitis in a Critically Ill Patient Following Severe <i>Legionella</i> Pneumonia with Multiple Organ Failure

Cytomegalovirus infection in gastrointestinal tract: A case series of three patients and review of literature

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