Severe Cytomegalovirus-Associated Esophagitis in an Immunocompetent Patient after Short-Term Steroid Therapy

Weile, Jan; Streeck, Benjamin; Muck, Johannes; Krebs, Gerd; Jakobus, Karl-Heinz; Knabbe, Cornelius; Weber, Friedhelm

doi:10.1128/jcm.00143-09

Cited by 31 publications

(18 citation statements)

References 12 publications

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“…Third, we did not perform basic research to explore the potential mechanisms by which the decline in BALF eosinophils may occur in patients with recurrent wheeze and concurrent CMV infection. Finally, we were unable to determine whether the higher prevalence of CMV DNA in the BALF of patients with recurrent wheeze resulted from virus reactivation as a consequence of airway inflammation or treatment with corticosteroids [ 16 , 17 ]. Evidence suggests that both might be possible explanations.…”

Section: Discussionmentioning

confidence: 99%

Associations between patient clinical characteristics and the presence of cytomegalovirus DNA in the bronchoalveolar lavage fluid of children with recurrent wheezing

Sun

Wang

et al. 2018

BMC Infect Dis

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BackgroundThis study aimed to investigate the occurrence of Cytomegalovirus (CMV) DNA in the Bronchoalveolar lavage fluid (BALF) of children with recurrent wheezing and to identify associations with certain patient clinical characteristics.MethodsIn this cross-sectional study, pediatric patients (age < 36 months) admitted to Soochow University Hospital with recurrent wheezing (≥ 4 episodes of wheezing per year) were enrolled in the study. Cytomegalovirus DNA from their BALF was detected by real-time PCR. Subpopulations of blood immunoglobulins and T lymphocytes were quantified. The clinical characteristics of patients with and without BALF CMV DNA were compared. Comparisons of non-normally distributed continuous variables between groups were made using the Mann-Whitney U-test. Comparisons of frequency distributions were made using the Chi-squared test. Spearman’s rank correlation coefficient was used to evaluate correlations between the number of CMV DNA copies and continuous variables.ResultsA total of 111 patients aged 4 to 36 months (median 14.0 (IQR 8.0–22.0) months) were enrolled on to the study. Cytomegalovirus DNA was detected in 51.4% of patients (n = 111) with recurrent wheeze and was more prevalent among those aged 12 to 36 months with a positive modified asthma predictive index (mAPI) (n = 38, median 23.5 (IQR 19.7–31.2) months) than in those of the same age group with a negative mAPI (n = 25, median 15.0 (IQR 13.0–19.0) months) (57.9% vs. 20.0%, p = 0.003). Bronchoalveolar lavage fluid CMV DNA copy number [median 7560 (IQR 1200–71,150) copies/mL] was positively correlated with the duration of hospitalization (r = 0.33, p = 0.013), and negatively correlated with patient age (r = − 0.41, p = 0.002) and the percentage of BALF eosinophils (r = − 0.38, p = 0.004).ConclusionsCMV infection or reactivation in children with recurrent wheeze is associated with certain clinical characteristics, including younger age and lower levels of BALF eosinophils. Higher CMV DNA copy numbers were associated with a longer duration of hospitalization. Further studies are needed to address whether specific antiviral treatment could be beneficial for BALF CMV positive patients.

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Section: Discussionmentioning

confidence: 99%

Associations between patient clinical characteristics and the presence of cytomegalovirus DNA in the bronchoalveolar lavage fluid of children with recurrent wheezing

Sun

Wang

et al. 2018

BMC Infect Dis

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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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“…While symptomatic CMV diseases are rare in COPD patients, chronic inflammation or treatment with corticosteroids may promote CMV-related complications including pneumonitis and esophagitis. 3 As COPD is a disease of old age, it is valid to consider how it may be affected by the impact of repeated CMV reactivations on the immune system. Furthermore, both COPD and CMV replication increase the incidence of age-associated systemic co-morbidities (e.g., cardiovascular diseases) and are associated with expanded populations of circulating CD28 null T cells (marker of immune senescence/aging) that are proinflammatory.…”

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confidence: 99%

Levels of CMV-reactive antibodies correlate with the induction of CD28null T cells and systemic inflammation in chronic obstructive pulmonary disease (COPD)

Tan¹,

Amran²,

Teo³

et al. 2015

Cell Mol Immunol

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Severe Cytomegalovirus-Associated Esophagitis in an Immunocompetent Patient after Short-Term Steroid Therapy

Cited by 31 publications

References 12 publications

Associations between patient clinical characteristics and the presence of cytomegalovirus DNA in the bronchoalveolar lavage fluid of children with recurrent wheezing

Associations between patient clinical characteristics and the presence of cytomegalovirus DNA in the bronchoalveolar lavage fluid of children with recurrent wheezing

Cytomegalovirus esophagitis in an immunocompetent patient: Case report

Levels of CMV-reactive antibodies correlate with the induction of CD28null T cells and systemic inflammation in chronic obstructive pulmonary disease (COPD)

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