Cytomegalovirus esophagitis in an immunocompetent patient: Case report

Abstract

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 ...

Infectious Esophagitis in Romanian Children: From Etiology and Risk Factors to Clinical Characteristics and Endoscopic Features

“…However, in our data, both mid-esophageal mucosa ulceration and acute inflammation were observed in all cases. Our results are in contrast with many previous clinical studies in adults and children [2,5,7,[19][20][21].…”

“…Similar to previous studies, our research can emphasize that dysphagia, followed by epigastralgia and hematemesis, were common symptoms [2,5,7]. Earlier data on this topic showed that distal ulcers are more common than mucosal inflammation [7,19,20]. In general, ulcers seen in CMV-induced esophagitis tend to be large and deep, and are more likely to be found in the distal section of the esophagus.…”

Evaluation and management of infectious esophagitis in immunocompromised patients and immunocompetent individuals

“…В последнее время наблюдается тенденция к росту заболеваемости среди здоровых лиц [48,49,[56][57][58][59][60][61]. Инфекция у иммунокомпетентных лиц чаще всего протекает бессимп-томно либо в форме мононуклеозоподобного синдрома.…”

“…Острые состояния, такие как кровоизлияние в головной мозг, инфекции в стадии обострения, обширные оперативные вмешательства также являются фактором риска реактивации латентной инфекции у иммунокомпетентных лиц вследствие серьезного снижения функционирования иммунной системы [61].…”

Extensive Esophageal Ulceration in a Renal Transplant Patient

“… 1 , 2 , 3 CMV esophagitis has mostly been described in patients with acquired immunodeficiency syndrome, however, also may occur as a complication of immunosuppressive therapy, or even in immunocompetent patients. 3 , 4 The gastro-intestinal tract is the commonest organ to be involved in CMV infection and esophagitis is the second most common gastrointestinal manifestation, next to colitis. 2 …”