Cytomegalovirus esophagitis associated with gastroesophageal reflux disease in an immunocompetent patient: case report

Main Article Content

Cesar Romaro Pozzobon
https://orcid.org/0000-0003-4385-2660
Fernanda Manhães Pozzobon
https://orcid.org/0000-0002-8968-9283
Geysa Bigi Maya Monteiro
Eduardo Madeira
https://orcid.org/0000-0001-9249-0681
Maria Chiara Chindamo
https://orcid.org/0000-0002-5817-9221

Abstract

Cytomegalovirus infection has a wide variability of clinical presentations depending on the patient's immunity, ranging from asymptomatic infections in immunocompetent individuals to infections with significant morbidity and mortality in immunocompromised patients. We originally described a clinical case of severe cytomegalovirus esophagitis, confirmed by blood polymerase chain reaction (PCR) test and esophageal biopsy, in a young immunocompetent patient with a long-standing diagnosis of gastroesophageal reflux disease. Clinical improvement occurred only after the initiation of specific treatment with ganciclovir, providing a negative viral load. This report reinforces the importance of ruling out the etiology of cytomegalovirus infection in severe ulcerative esophagitis, even in immunocompetent individuals.

Article Details

How to Cite
Pozzobon, C. R., Pozzobon, F. M., Monteiro, G. B. M., Madeira, E., & Chindamo, M. C. (2023). Cytomegalovirus esophagitis associated with gastroesophageal reflux disease in an immunocompetent patient: case report. Brazilian Journal of Case Reports, 4(1), 36–41. https://doi.org/10.52600/2763-583X.bjcr.2024.4.1.36-41
Section
Clinical Case Reports
Author Biographies

Cesar Romaro Pozzobon, Rede D’or São Luiz, Barra D’Or Hospital

Rede D’or São Luiz, Barra D’Or Hospital, Rio de Janeiro, Brazil.

Federal University of Rio de Janeiro (UFRJ), Worker’s Health Care Superintendence, Rio de Janeiro, Brazil.

Fernanda Manhães Pozzobon, Rede D’or São Luiz, Barra D’Or Hospital

Rede D’or São Luiz, Barra D’Or Hospital, Rio de Janeiro, Brazil.

Fluminense Federal University (UFF), Health Assistance Division, Niterói, RJ, Brazil.

Geysa Bigi Maya Monteiro, Rede D’or São Luiz, Quinta D’Or Hospital, Anatomical Pathology Department

Rede D’or São Luiz, Quinta D’Or Hospital, Anatomical Pathology Department, Rio de Janeiro, Brazil.

Eduardo Madeira, Rede D’or São Luiz, Barra D’Or Hospital

Rede D’or São Luiz, Barra D’Or Hospital, Rio de Janeiro, Brazil.

Federal University of Rio de Janeiro (UFRJ), Worker’s Health Care Superintendence, Rio de Janeiro, Brazil.

Maria Chiara Chindamo, Rede D’or São Luiz, Barra D’Or Hospital

Rede D’or São Luiz, Barra D’Or Hospital, Rio de Janeiro, Brazil

Federal University of Rio de Janeiro (UFRJ), Hepatology Department, Rio de Janeiro, Brazil.

References

Cohen JI, Corey GR. Cytomegalovirus infection in the normal host. Medicine. 1985;64(2):100-14. doi: 10.1097/00005792-198503000-00003.

Wang H-W, Kuo C-J, Lin W-R, Hsu C-M, Ho Y-P, Lin C-J. The clinical characteristics and manifestations of cytomegalovirus esophagitis. Diseases of the Esophagus. 2016;29(4):392-9. doi: 10.1111/dote.12340.

Chaemsupaphan T, Limsrivilai J, Thongdee C, Sudcharoen A, Pongpaibul A, Pausawasdi N. Patient characteristics, clinical manifestations, prognosis, and factors associated with gastrointestinal cytomegalovirus infection in immunocompetent pa-tients. BMC gastroenterology. 2020;20:1-12. doi: 10.5694/mja14.00183.

Lancini D, Faddy HM, Flower R, Hogan C. Cytomegalovirus disease in immunocompetent adults. Medical Journal of Aus-tralia. 2014;201(10):578-80. doi: 10.1186/s12876-020-1174-y.

Rafailidis PI, Mourtzoukou EG, Varbobitis IC, Falagas ME. Severe cytomegalovirus infection in apparently immunocom-petent patients: a systematic review. Virology journal. 2008;5:1-7. doi: 10.1186/1743-422X-5-47.

Wreghitt T, Teare E, Sule O, Devi R, Rice P. Cytomegalovirus infection in immunocompetent patients. Clinical infectious diseases. 2003;37(12):1603-6. doi: 10.1086/379711.

Al-Omari A, Aljamaan F, Alhazzani W, Salih S, Arabi Y. Cytomegalovirus infection in immunocompetent critically ill adults: literature review. Annals of intensive care. 2016;6(1):1-14. doi: 10.1001/jama.300.4.413.

Limaye AP, Kirby KA, Rubenfeld GD, Leisenring WM, Bulger EM, Neff MJ. Cytomegalovirus reactivation in critically ill immunocompetent patients. Jama. 2008;300(4):413-22. doi: 10.1186/s13613-016-0207-8.

Lim DS, Lee TH, Jin SY, Lee JS. Cytomegalovirus esophagitis in an immunocompetent patient: case report. Turk J Gastroen-terol. 2014;25(5):571-4. doi: 10.5152/tjg.2014.4073.

Weile J, Streeck B, Muck J, Krebs G, Jakobus K-H, Knabbe C. Severe cytomegalovirus-associated esophagitis in an immu-nocompetent patient after short-term steroid therapy. Journal of clinical microbiology. 2009;47(9):3031-3. doi: 10.1128/jcm.00143-09.

Bonnet F, Morlat P, Neau D, Viallard J, Ragnaud J, Dupon M. Hematologic and immunologic manifestations of primary cytomegalovirus infections in non-immunocompromised hospitalized adults. La Revue de Medecine Interne. 2000;21(7):586-94. doi: 10.1016/s0248-8663(00)80003-x.

Marques S, Carmo J, Pinto D, Bispo M, Ramos S, Chagas C. Cytomegalovirus disease of the upper gastrointestinal tract: a 10-year retrospective study. GE-Portuguese Journal of Gastroenterology. 2017;24(6):262-8. doi: 10.1159/000479232.

Narasimhalu T, Olson KA. Educational case: Infectious esophagitis. Academic Pathology. 2020;7:2374289520903438. doi:10.1177/2374289520903438.