The clinical characteristics and manifestations of cytomegalovirus esophagitis

Abstract

Esophagitis is the second most common gastrointestinal manifestation of cytomegalovirus (CMV) infection after colitis. CMV esophagitis has been reported in patients who have undergone transplantation, are on long-term renal dialysis, or who have the human immunodeficiency virus infection. This study aimed to investigate the clinical characteristics and manifestations of CMV esophagitis in patients who underwent diagnostic endoscopy. A total of 16 patients with histologically proven CMV infection were identified from 1539 patients with esophageal ulcers and analyzed retrospectively (January 2006 to December 2013). Patients' personal data (age, smoking, and alcohol consumption), underlying systemic diseases (diabetes mellitus, end-stage renal disease, and chronic obstructive pulmonary disease), malignancy, indication for esophagogastroduodenoscopy, endoscopic characteristics, and diagnostic methods (pathological or serological findings) were collected for further analysis. Among the patients with CMV esophagitis, the mean age was 59.94 years (range, 23-84 years). The male : female ratio was 1.67:1. Odynophagia and epigastralgia were common symptoms. Of the 16 patients, 3 (18.75%) were infected with the human immunodeficiency virus and 9 (56.25%) had an underlying malignancy, including lung cancer (6 patients), esophageal cancer (2 patients), gastric cancer (1 patient), ampulla of Vater cancer (1 patient), and lymphoma (1 patient). Six of the 9 patients (66.7%) with malignancy had been administered concurrent chemoradiotherapy (CCRT). In this study, patients with malignancy who had been administered CCRT were at increased risk for CMV esophagitis, which had not been reported before in the literature. CMV esophagitis should be considered as a potential treatment-related complication of CCRT.

Cytomegalovirus Disease of the Upper Gastrointestinal Tract: A 10-Year Retrospective Study

“…CMV disease of the GI tract is a common manifestation of CMV infection and the colon is the most frequently involved GI segment [1] . However, the literature is scarce regarding CMV disease of the upper GI tract.…”

“…Cytomegalovirus (CMV) disease of the gastrointestinal (GI) tract is a major cause of morbidity and mortality in immunocompromised patients [1][2][3] . Patients at increased risk for GI CMV infection are those with acquired immunodeficiency syndrome (AIDS), recipients of solid and bone marrow transplants, those receiving immunosuppressive therapy, and patients with malignancies, especially those under chemotherapy or with hematological malignancies [1][2][3] .…”

“…Patients at increased risk for GI CMV infection are those with acquired immunodeficiency syndrome (AIDS), recipients of solid and bone marrow transplants, those receiving immunosuppressive therapy, and patients with malignancies, especially those under chemotherapy or with hematological malignancies [1][2][3] . The colon is the most commonly affected site in GI CMV disease.…”

“…Symptomatic patients may complain of dysphagia/odynophagia, nausea/vomiting, abdominal pain, and weight loss [1,4] . Diagnosis of GI CMV disease relies mostly on endoscopy and GI biopsy.…”

“…Histopathological diagnosis is made with the identification of CMV inclusion bodies on histology or with a positive immunohistochemical staining using anti-CMV monoclonal antibodies ( Fig. 1 ) [1,3] . A 2-to 3-week course of antiviral treatment with intravenous (i.v.)…”