Abstract
Purpose: A 52-year old male with a history of HIV, CD4 count of less than 200, was referred for an EGD for evaluation of dysphagia. The patient was found to have esophageal ulcerations. Several small diverticular openings were also noted throughout the esophagus, typical for esophageal pseudodiverticulosis. The biopsies that were obtained of the ulcerated areas were consistent with CMV esophagitis. The patient's symptoms improved with treatment. Discussion: Esophageal intramural pseudodiverticulosis is a rare disorder characterized on esophagogram by multiple flask shaped outpouchings in the esophageal wall. The diverticula are thought to represent dilated excretory ducts of the submucosal glands. Dilation of the ducts might be caused by obstruction with inflammatory material or extrinsic compression due to periductal inflammation with fibrosis. Pseudodiverticula can number from a few to a hundred or more. It is believed to be an acquired condition. While the precise pathogenesis is uncertain, chronic inflammation and stasis appear to be predisposing factors. This condition has been commonly associated with chronic esophagitis and diabetes and less commonly with esophageal candidiasis. This is the first time that an association between CMV, HIV, and esophageal pseudodiverticulosis has been reported.Figure: No Caption available.
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