Infectious Esophagitis
Cytomegalovirus Esophagitis

Video Endoscopic Sequence 1 of 4.

Cytomegalovirus Esophagitis

This the case of a 38 year-old male, an upper endoscopy was performed because of chest pain, was diagnosed retrospectively which suffers of Acquired Immunodeficiency Syndrome (AIDS).

Esophagitis is the second most common gastrointestinal (GI) manifestation of cytomegalovirus (CMV) infection after colitis. CMV esophagitis has been reported in patients who have undergone transplantation, patients undergoing long-term renal dialysis, patients with human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS), and patients with other debilitating diseases.

Cytomegalovirus Esophagitis

 

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Cytomegalovirus Esophagitis

Video Endoscopic Sequence 2 of 4.

Mimics of the symptoms of CMV esophagitis include the following:

· Achalasia
· Barrett Esophagus and Barrett Ulcer
· Candidiasis
· Cryptococcosis
· Esophageal Cancer
· Gastroesophageal Reflux Disease
· Herpes Simplex
· Histoplasmosis
· Tuberculosis
The following conditions should also be considered in the
diagnosis:
· Aphthous/idiopathic ulcers (commonly seen in patients with AIDS)
· Drug-induced dysphagia
· Epstein-Barr virus infection

 

 

Endoscopy of Cytomegalovirus Esophagitis

Video Endoscopic Sequence 3 of 4.

Cytomegalovirus Esophagitis

Patients with CMV esophagitis may have superimposed CMV colitis (in which case, care at a skilled nursing facility may be necessary).

Patients with HIV infection are at increased risk because
their CD4+ lymphocyte counts fall to less than 100 cells/µL
. In patients with HIV infection or AIDS, CMV infection is
an opportunistic infection that signals a decline in patient
immunity.

CMV esophagitis has been described in only 3 patients
who had been immunocompromised by conditions other
than transplantation, HIV infection, or AIDS. No cases
have been reported in healthy hosts.

 

Endoscopy of Cytomegalovirus Esophagitis

Video Endoscopic Sequence 4 of 4.

Cytomegalovirus Esophagitis

Risk factors that predispose individuals to cytomegalovirus esophagitis include the following:

· HIV infection or AIDS
· High- or low-dose corticosteroid therapy
· Immunosuppressive therapy following transplant
· History of blood transfusion
· Advancing age
· Anything that can decrease an individual’s immunity
Potential complications of cytomegalovirus esophagitis
include the following:
· Stricture formation
· Perforation (rarely)

 

Infectious Esophagitis

Video Endoscopic Sequence 1 of 4.

Infectious Esophagitis to be determined

This is a 75 year-old female, who in upper endoscopy is found multiple ulcers of the middle and lower third, multiple biopsies are taken, at the moment we do not have the results of the biopsies.

 

 


Infectious Esophagitis

Video Endoscopic Sequence 2 of 4.

Infectious Esophagitis to be determined

Esophageal ulcers due to infection to be determined according the result of the biopsies.

 

Infectious Esophagitis

Video Endoscopic Sequence 3 of 4.

Esophageal ulcers due to infection to be determined according the result of the biopsies.

 

Infectious Esophagitis

Video Endoscopic Sequence 4 of 4.

Esophageal ulcers due to infection to be determined according the result of the biopsies.

 

Cytomegalovirus Esophagitis

Video Endoscopic Sequence 1 of 4.

Cytomegalovirus Esophagitis

This 42 year-old male underwent a rutine upper endoscopy finding this tiny lesion in the upper third of the esophagus immediately suspect as herpes viral esophagitis or cytomegalovirus, subsequently confirmed by biopsies, subsequently confirmed by being HIV positive blood test.

Cytomegalovirus (CMV) is a member of the Herpesviridae family, along with herpes simplex viruses (HSVs) 1 and 2, Epstein-Barr virus, varicella-zoster virus, and others. CMV is a double-stranded DNA virus with a protein coat and lipoprotein envelope.







Endoscopy of Cytomegalovirus Esophagitis

Video Endoscopic Sequence 2 of 4.

Endoscopy of Cytomegalovirus Esophagitis

Usually an opportunistic infection, among the most common opportunistic infections in AIDS patients, but also in non-HIV immunocompromised patients (bone marrow transplant recipients, solid organ transplant recipients, patients with malignancies and rheumatologic disorders, patients receiving immunosuppressive therapy).

Endoscopic Featuressolitary (usually) or multiple shallow ulcers in the distal esophagus, occasionally extending in the mid esophagus. - may become large in AIDS or other immunosuppressed patients.

Differential Diagnosis

ENDOSCOPIC

- Herpes - small multiple ulcers
- Candida - white exudates
- Pill - mid esophageal solitary or "kissing" ulcers

MORPHOLOGIC

- Herpes - multinucleated giant cells with intranuclear
inclusions in the squamous epithelium at the ulcer edge.
- Candida - fungal pseudohyphae in the exudate.
- Pill - ulcer of squamous epithelium without viral cytopathic
effect or fungi.


 

Endoscopy of Cytomegalovirus Esophagitis

Video Endoscopic Sequence 3 of 4.

CMV GI disease was first described in the 1960s.
Esophagitis is the second most common GI manifestation
of CMV infection after colitis. CMV esophagitis has been
reported in patients who have undergone transplantation,
patients undergoing long-term renal dialysis, patients with
HIV infection or AIDS, and patients with other debilitating
diseases.

The average time to development of CMV esophagitis
after solid organ transplantation is 5-7 months. Patients
undergoing bone marrow transplantation may develop
CMV disease much earlier, at an average of 2-3 months
with symptoms occurring as early as 10 days after allogenic
bone marrow transplantation. Patients with HIV infection
are at increased risk because their CD4+ lymphocyte
counts fall to less than 100 cells/µL.

Approximately 8-28% of patients with AIDS who undergo
esophagogastroduodenoscopy (EGD) for dysphagia or
odynophagia are found to have cultures positive for CMV.
Approximately 38% of bone marrow transplant patients
who undergo EGD for unexplained nausea and vomiting
are positive for CMV esophagitis and/or small intestine
involvement. CMV esophagitis has been described in only
3 patients immunocompromised by conditions other than
transplantation, HIV infection, or AIDS. No cases have
been reported in healthy hosts.

 

Endoscopy of Cytomegalovirus Esophagitis

Video Endoscopic Sequence 4 of 4.

Characteristic giant cell with inclusion body in a patient
with cytomegalovirus esophagitis.


ytomegalovirusxcv4
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