Cytomegalovirus esophagitis is one of the many types of infections caused by the cytomegalovirus and is primarily seen in immunocompromised individuals. Odynophagia, pain in the epigastric region, swallowing difficulties, vomiting, and nausea are some of the most important symptoms. A detailed clinical workup, microbiological studies, and upper endoscopy are vital components of the diagnostic workup.
Cytomegalovirus (CMV) is described as a causative agent of numerous end-organ infections in clinical practice  , and is mainly identified in immunocompromised hosts, such as those suffering from human immunodeficiency virus (HIV) infection, organ transplant recipients, dialysis patients, or other disorders that induce a severe immunosuppression (use of corticosteroids, congenital immunodeficiencies, etc.)   . However, a growing number of studies report CMV infection in the immunocompetent, both in children and adults   . Cytomegalovirus esophagitis, after CMV colitis, is the second most common site of gastrointestinal tract infection by this viral pathogen , and the clinical presentation ranges from asymptomatic with mild upper-GI related complaints (typical for immunocompetent) to severely debilitating  . Symptomatic patients present with odynophagia and dysphagia (swallowing of solid foods is particularly unpleasant and painful, whereas liquids are better tolerated), as well as pain in the epigastric, substernal or pharyngeal region     . Pain may be accompanied by a burning sensation and is often pronounced by ingestion of acidic beverages . Difficulties with swallowing might reach up to a point where patients suffer from weight loss and dehydration, which can be further aggravated by nausea and vomiting, two frequent complaints in cytomegalovirus esophagitis  . Fever is also reported in a minority of patients .
Entire Body System
MEASUREMENTS AND MAIN RESULTS: Odynophagia was the most prominent esophageal symptom, seen in 14 of 16 patients with cytomegalovirus esophagitis confirmed by immunohistochemical staining. [ncbi.nlm.nih.gov]
It should be suspected in an immunocompromised patient with odynophagia, persistent central chest/epigastric pain, nausea, vomiting, and/or hematemesis. [clinicaladvisor.com]
- Coffee Ground Emesis
Case Presentation: A 80-year-old female with a past medical history of diabetes mellitus, hypertension and coronary artery disease status post stenting 4 years ago presented with coffee ground emesis, epigastric pain, dysphagia and melena. [shmabstracts.com]
The differential diagnosis of symptoms related to the upper GI tract is broad. For this reason, physicians should obtain a proper patient history that will identify underlying immunosuppressive disorders that could point toward CMV esophagitis. After a detailed physical examination, the two most important parts of the workup are microbiological testing and imaging studies of the esophagus. Various methods have been described in the literature as a means of detecting CMV as the causative agent, including viral cultures, immunohistochemical staining, and serology, but the emergence of molecular methods, such as polymerase chain reaction (PCR) and reverse-transcriptase PCR (RT-PCR), has greatly improved the overall success of microbiological diagnosis   . To obtain a viable sample for testing, however, it is necessary to perform an upper endoscopy that allows a biopsy with subsequent histopathological examination, which is also useful in confirming CMV as the culprit . This procedure is equally important for solidifying CMV as the cause of esophagitis, as it allows a direct view of the esophageal lining. Although lesions may not be visible in all patients, erythema, exudation, erosions, and edema are common findings . A more concrete diagnosis of CMV esophagitis can be made in the presence of large solitary or multiple ulcers (often referred to as "punched-out" lesions) in the distal or middle part of the esophagus, considered as hallmarks of this infection    .
Cellular immunity is particularly important and corticosteroid treatment increases the risk of CMV infection substantially. [ncbi.nlm.nih.gov]
Treatment with gancicrovir (GCV) resulted in resolution of the fever and improved the nausea. After the treatment, intranuclear inclusions were no longer detected on tumor biopsy, and the test for CMV antigenemia also became negative. [doi.org]
Treatment of CMV Esophagitis The treatment for cytomegalovirus esophagitis is intravenous administration of ganciclovir or foscarnet. [healthinplainenglish.com]
Frequency of adverse events was comparable with both drugs: only one patient in each group suspended treatment because of severe side effects. [nature.com]
Cytomegalovirus esophagitis was associated with a poor long-term prognosis. [ncbi.nlm.nih.gov]
Despite infection, early diagnosis and treatment helped resolve the problem with a good prognosis in this case. [kjim.org]
Prognosis and Patient Counseling. CMV infection in the immunocompetent host often resolves spontaneously without intervention or sequelae. [clinicaladvisor.com]
Retrospective review was also made of the course of patients who had been found to have both Candida and CMV infection during a previous prospective endoscopic study investigating the etiology of esophageal symptoms in HIV infection. [journals.lww.com]
We suspected that the etiology of esophagitis was ischemia due to vasculitis induced by CMV infection. [ci.nii.ac.jp]
(Etiology) Cytomegalovirus (CMV) Esophagitis is caused by a virus called cytomegalovirus CMV Esophagitis disease is an indication of a frail immune system that is caused by other medical conditions or viral infections The cytomegalovirus occurs latently [dovemed.com]
Esophageal disease in the acquired immunodeficiency syndrome: Etiology, diagnosis, and management. Am J Med 1992; 92 : 412–421. 7. Bonacini, M, Laine, L. Detection of cytomegalovirus in the gastrointestinal tract: Seeking a gold standard. [nature.com]
Etiology Pathogen : cytomegalovirus ( CMV, human herpes virus 5, HHV-5 ) Transmission Blood transfusions Sexual transmission Droplet transmission Transplant-transmitted infection (e.g., bone marrow, lungs, kidneys) References:    Pathophysiology [amboss.com]
Jeffrey D Band, MD, FACP, FIDSA Professor of Medicine, Oakland University William Beaumont School of Medicine; Health System Chair, Healthcare Epidemiology and International Medicine, Beaumont Health System; Former Chief of Infectious Diseases, Beaumont [emedicine.medscape.com]
Epidemiology Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
“Congenital cytomegalovirus (CMV) epidemiology and awareness”. J Clin Virol. vol. 46. 2009; Dec. pp. S6-S10. [dermatologyadvisor.com]
Epidemiology Approximately 50% of the world’s population is infected with H pylori; prevalence of H pylori infection in the U.S. is about 35–40%. [atsu.edu]
The basic epidemiology: A neonate acquiring CMV infection is infected when the mother has a primary CMV infection during pregnancy. Reactivation of CMV during pregnancy may account for a small number of congenital CMV infections. [infectiousdiseaseadvisor.com]
Unlike others on this topic, this text demonstrates how the endoscope incorporates pathophysiology, diagnostic, and treatment modalities into endoscopic practice. [books.google.de]
bone marrow, lungs, kidneys) References:    Pathophysiology Clinical features CMV infection is usually asymptomatic. Severe manifestations occur in immunocompromised states (e.g., following organ transplantation, AIDS ). [amboss.com]
Pathophysiology Upon infection of cells, CMV causes cytomegaly and condensation of the nuclear mass, while infection of organs results in inflammation and resultant organ dysfunction. [dermatologyadvisor.com]
Generally, CMV infections can be prevented by averting immunodeficiency infections, providing suitable treatment and medical care after an organ transplant (especially lung or bone marrow), and prompt aggressive treatment, when a body immunity system [dovemed.com]
Special chapters, such as the Designing Clinical Research in Gastrointestinal Endoscopy, The Prevention of Infection Following Gastrointestinal Endoscopy, Complications of Peptic Ulcer Disease, and Credentialing for Gastrointestinal Endoscopy, help make [books.google.de]
Because most patients affected by cytomegalovirus (CMV) esophagitis have HIV infection, the increased use of these newer therapies has helped in the prevention and treatment of CMV disease. [emedicine.medscape.com]
- Weile J, Streeck B, Muck J, et al. Severe Cytomegalovirus-Associated Esophagitis in an Immunocompetent Patient after Short-Term Steroid Therapy. J Clin Microbiol. 2009;47(9):3031-3033.
- Ljungman P, Griffiths P, Paya C. Definitions of cytomegalovirus infection and disease in transplant recipients. Clin Infect Dis. 2002;34(8):1094-1097.
- Lim DS, Lee TH, Jin SY, Lee JS. Cytomegalovirus esophagitis in an immunocompetent patient: case report. Turk J Gastroenterol. 2014;25(5):571-574.
- Wang HW, Kuo CJ, Lin WR, et al. The clinical characteristics and manifestations of cytomegalovirus esophagitis. Dis Esophagus. 2016 May;29(4):392-399.
- Bernard S, Germi R, Lupo J, et al. Symptomatic cytomegalovirus gastrointestinal infection with positive quantitative real-time PCR findings in apparently immunocompetent patients: a case series. Clin Microbiol Infect. 2015;21(12):1121.e1-7.
- Bhat V, Joshi A, Sarode R, Chavan P. Cytomegalovirus infection in the bone marrow transplant patient. World J Transplant. 2015;5(4):287-291.
- Hanisch BR, Belani K. CMV esophagitis as a cause of failure to thrive. Minn Med. 2014;97(9):50.