A 36-year-old man with a 5-year history of untreated human immunodeficiency virus (HIV) infection had odynophagia for 14 days. Fifteen days earlier, he had begun taking trimethoprim-sulphamethoxazole and combination antiretroviral therapy that included lamivudine, zidovudine, and nelfinavir. He had no history of opportunistic infection. The CD4 lymphocyte count was 67/microL and HIV-RNA level was 359,396 copies/mL. Esophagogastroduodenoscopy revealed a large, well-circumscribed esophageal ulceration 31 cm from the incisors. Histopathologic examination of esophageal biopsy specimens showed cytopathic changes diagnostic of cytomegalovirus (CMV). In situ DNA hybridization was positive for CMV. While combination antiretroviral therapy was continued, the esophageal symptoms resolved within 4 days of endoscopy without specific therapy for CMV. Follow-up endoscopy 4 weeks later revealed a normal-appearing esophagus, and the patient has remained symptom-free for 10 months.
"The major reason for this finding may well be the immunodeficiency due to dysfunction of T-cell-response in the patients after several years. Monkemuller and Wilcox (2000) reported a case of CMV esophagitis in a patient with AIDS that improved by treatment with antiretroviral therapy alone without anti CMV therapy. After bone marrow transplantation, Zaia (2002) states among other risk factors for CMV disease the failure of lymphoid reconstitution post transplantation. "
[Show abstract][Hide abstract] ABSTRACT: Cytomegalovirus (CMV) positive recipients of CMV negative bone marrow bear a significantly higher risk of developing CMV disease compared to all other constellations. Here, we report a case of severe CMV induced esophagitis after allogeneic bone marrow transplantation for paroxysmal nocturnal hemoglobinuria. The patient developed the first symptoms between day 10 and 20 after dose reduced conditioning and HLA-matched unrelated stem cell transplantation. Esophageal tissue biopsies as well as peripheral blood proved positive for CMV DNA by PCR. Treatment with acyclovir, ganciclovir, foscarnet, cidofovir, and immunoglobulines resulted in elimination of CMV in peripheral blood but not in clinical improvement. Only tapering of cyclosporine at day +120 eventually led to the development of CMV-specific T-cells and resolution of esophagitis.
"Usually, resolution of symptoms and endoscopic findings is obtained with IV ganciclovir or foscarnet. Combined antiretroviral therapies may also be effective, even without specific treatment of CMV . However, in the case of perforation, despite immediate surgical resection and antiviral therapy, mortality rate remains elevated (> 80%), due to elevated operative mortality and increased postoperative complications [17,18]. "
[Show abstract][Hide abstract] ABSTRACT: Active Cytomegalovirus (CMV) infection is a common complication in advanced symptomatic Human Immunodeficiency Virus (HIV) infection. CMV-induced intestinal perforations are hard to diagnose and may be observed throughout the gastrointestinal tract. Isolated stomach perforation is exceptional.
A 47-year-old man was admitted to our intensive care unit with multiorgan failure. Gastrointestinal endoscopic examination showed erythematous gastritis but normal duodenum and colon. CMV blood culture was positive. Histologic examination of a gastric biopsy showed inflammatory infiltrate and immunostaining typical intranuclear CMV inclusion bodies. Concomitant abdominal CT scan disclosed large peripancreatic hypodensities without pneumoperitoneum. The patient died despite supportive therapies and ganciclovir infusion. Postmortem examination showed a 4-cm gastric perforation adhering to the transverse colon and liver, with a thick necrotic inflammatory coating around the pancreas. The whole GI tract, except the stomach, was normal. As other causes, especially Helicobacter pylori infection could be ruled out, a causal relationship between CMV and gastric disease was assumed.
CMV may be responsible for gastric perforations, with difficulties in assessing the diagnosis. Early diagnosis based on cautious endoscopy and histopathologic examination is needed to make a favorable outcome possible.
[Show abstract][Hide abstract] ABSTRACT: Opportunistic infections during primary infection with human immunodeficiency virus type 1 have occasionally been reported in the medical literature, and those caused by cytomegalovirus have tended to be severe and prolonged. We describe a 40-year-old man who had acute retroviral syndrome complicated by a severe cytomegalovirus-induced esophageal ulceration, which was successfully treated with total parenteral nutrition and ganciclovir in addition to highly active antiretroviral therapy.
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