Cytomegalovirus esophagitis

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Cytomegalovirus esophagitis
Specialty Gastroenterology, Infectious disease

Cytomegalovirus esophagitis is a form of esophagitis associated with cytomegalovirus. [1] Symptoms include dysphagia, upper abdominal pain, diarrhea, nausea, vomiting, and sometimes hematemesis. This condition occurs in the setting of patients with a weakened immune system who are susceptible to both infections by CMV and the manifestation of symptoms. A large majority of patient that have CMV Esophagitis are diagnosed with HIV. Another significant segment of the population have weakened immune systems through transplant surgery, diabetes, or due to medication. Diagnosis is done primarily by endoscopy with biopsy, as CMV Esophagitis has a distinctive pathology pattern of linear ulcers. [2]

Contents

Signs and Symptoms

  1. Dysphagia: Difficulty or pain while swallowing
  2. Hematemesis: Blood while vomiting
  3. Abdominal Pain: Pain in the upper abdominal area, usually exacerbated by swallowing. Pain can also manifest as heartburn symptoms
  4. Nausea/vomiting
  5. Fever [3]

Transmission

There are multiple ways cytomegalovirus can be transmitted. Mother to child transmission is common after childbirth. It can also be spread through blood or sex. Transmission via salvia, tears, or skin contact is rare. [4]

Diagnosis

The most effective diagnostic tool for CMV is endoscopy with biopsy. Generally on inspection of the esophagus large punched out lesions are seen in the middle part of the esophagus. Further histological evaluation of the lesions demonstrates enlarged cells in the sub-epithelial layer with inclusions within the cell's nucleus and its cytoplasm. In addition to the histological examination fluorescent staining with an immunoperoxidase stain is highly specific. Radiologic imaging techniques such as X-Rays or CT Scans are not effective in diagnosing CMV Esophagitis but can identify any resulting strictures or fistulas. [5]

Pathology

Macroscopy:

On a macroscopic basis, CMV Esophagitis may appear to be punched out lesions.

Microscopy:

Histology of CMV Esophagitis demonstrates enlarged cells with inclusions within both the cytoplasm and the nucleus of the cell. Also aggregates of macrophage cells are common on microscopic examination. [5]

Treatment

Treatment revolves around intravenous treatment of ganciclovir. Alternate treatments involve valganciclovir, or foscarnet. All of these medication can cause nausea, diarrhea, fever, loss of appetite. Rarer side effects include anemia and tremors. [6]

Related Research Articles

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<span class="mw-page-title-main">Barrett's esophagus</span> Medical condition

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<span class="mw-page-title-main">Esophagitis</span> Medical condition

Esophagitis, also spelled oesophagitis, is a disease characterized by inflammation of the esophagus. The esophagus is a tube composed of a mucosal lining, and longitudinal and circular smooth muscle fibers. It connects the pharynx to the stomach; swallowed food and liquids normally pass through it.

Coffee ground vomitus refers to a particular appearance of vomit. Within organic heme molecules of red blood cells is the element iron, which oxidizes following exposure to gastric acid. This reaction causes the vomitus to look like ground coffee.

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<span class="mw-page-title-main">Herpes esophagitis</span> Medical condition

Herpes esophagitis is a viral infection of the esophagus caused by Herpes simplex virus (HSV).

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<span class="mw-page-title-main">Lymphocytic esophagitis</span> Medical condition

Lymphocytic esophagitis is a rare and poorly understood medical disorder involving inflammation in the esophagus. The disease is named from the primary inflammatory process, wherein lymphocytes are seen within the esophageal mucosa. Symptoms of the condition include difficulty swallowing, heartburn and food bolus obstruction. The condition was first described in 2006 by Rubio and colleagues. Initial reports questioned whether this was a true medical disorder, or whether the inflammation was secondary to another condition, such as gastroesophageal reflux disease.

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References

  1. Meinhard Classen; G. N. J. Tytgat; Charles J. Lightdale (2010). Gastroenterological Endoscopy. Thieme. pp. 490–. ISBN   978-3-13-125852-6 . Retrieved 3 November 2010.
  2. Robbins and Cotran pathologic basis of disease. Kumar, Vinay, 1944-, Abbas, Abul K.,, Aster, Jon C.,, Perkins, James A. (Ninth ed.). Philadelphia, PA. 2014. ISBN   9781455726134. OCLC   879416939.{{cite book}}: CS1 maint: others (link)
  3. Marques, Susana; Carmo, Joana; Pinto, Daniel; Bispo, Miguel; Ramos, Sância; Chagas, Cristina (2017). "Cytomegalovirus Disease of the Upper Gastrointestinal Tract: A 10-Year Retrospective Study". GE - Portuguese Journal of Gastroenterology. 24 (6): 262–268. doi:10.1159/000479232. ISSN   2341-4545. PMC   5731150 . PMID   29255766.
  4. "About Cytomegalovirus and Congenital CMV Infection | CDC". www.cdc.gov. 2019-11-04. Retrieved 2019-11-19.
  5. 1 2 Zaidi, Syed Ali; Cervia, Joseph S. (April 2002). "Diagnosis and Management of Infectious Esophagitis Associated with Human Immunodeficiency Virus Infection". Journal of the International Association of Physicians in AIDS Care. 1 (2): 53–62. doi:10.1177/154510970200100204. ISSN   1545-1097. PMID   12942677. S2CID   38823534.
  6. Parente, F.; Porro, Bianchi (March 1998). "Treatment of Cytomegalovirus Esophagitis in Patients With Acquired Immune Deficiency Syndrome: A Randomized Controlled Study of FoscarnetVersusGanciclovir". American Journal of Gastroenterology. 93 (3): 317–322. doi:10.1111/j.1572-0241.1998.00317.x. ISSN   0002-9270. PMID   9517631.