Cytomegalovirus esophagitis is a form of

esophagitis 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; s ...

associated with

cytomegalovirus ''Cytomegalovirus'' (''CMV'') (from ''cyto-'' 'cell' via Greek - 'container' + 'big, megalo-' + -''virus'' via Latin 'poison') is a genus of viruses in the order ''Herpesvirales'', in the family ''Herpesviridae'', in the subfamily ''Betaherpe ...

. Symptoms include

dysphagia Dysphagia is difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, in some contexts it is classified as a disease#Terminology, condition in its own right. It may be a sensation that suggests difficulty in the passag ...

, upper abdominal pain, diarrhea, nausea, vomiting, and sometimes

hematemesis Hematemesis is the vomiting of blood. It is always an important sign. It can be confused with hemoptysis (coughing up blood) or epistaxis (nosebleed), which are more common. The source is generally the upper gastrointestinal tract, typically abo ...

. 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 The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune ...

. Another significant segment of the population have weakened immune systems through transplant surgery,

diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ap ...

, or due to medication. Diagnosis is done primarily by endoscopy with biopsy, as CMV Esophagitis has a distinctive pathology pattern of linear ulcers.

Signs and Symptoms

# Dysphagia: Difficulty or pain while swallowing # Hematemesis: Blood while vomiting # Abdominal Pain: Pain in the upper abdominal area, usually exacerbated by swallowing. Pain can also manifest as heartburn symptoms # Nausea/vomiting # Fever

Transmission

There are multiple ways

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.

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 cell biology, the cytoplasm is all of the material within a eukaryotic cell, enclosed by the cell membrane, except for the cell nucleus. The material inside the nucleus and contained within the nuclear membrane is termed the nucleoplasm. The ...

. 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.

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 Macrophages (abbreviated as M φ, MΦ or MP) ( el, large eaters, from Greek ''μακρός'' (') = large, ''φαγεῖν'' (') = to eat) are a type of white blood cell of the immune system that engulfs and digests pathogens, such as cancer cel ...

cells are common on microscopic examination.

Treatment

Treatment revolves around intravenous treatment of

ganciclovir Ganciclovir, sold under the brand name Cytovene among others, is an antiviral medication used to treat cytomegalovirus (CMV) infections. Ganciclovir was patented in 1980 and approved for medical use in 1988. Medical use Ganciclovir is indicated f ...

. Alternate treatments involve

valganciclovir Valganciclovir, sold under the brand name Valcyte among others, is an antiviral medication used to treat cytomegalovirus (CMV) infection in those with HIV/AIDS or following organ transplant. It is often used long term as it only suppresses rath ...

, or

foscarnet Foscarnet (phosphonomethanoic acid), known by its brand name Foscavir, is an antiviral medication which is primarily used to treat viral infections involving the Herpesviridae family. It is classified as a pyrophosphate analog DNA polymerase inhib ...

. All of these medication can cause nausea, diarrhea, fever, loss of appetite. Rarer side effects include anemia and tremors.

References

External links

{{Digestive system diseases Inflammations Esophagus disorders Cytomegalovirus-associated diseases