Abstract
Immunocompromised patients with acquired immunodeficiency syndrome (AIDS) can develop opportunistic esophageal candidial and cytomegaloviral infections. A case is reported which extends the clinico-endoscopic severity of these infections. A 32-year-old bisexual man with AIDS since 1997, and intermittently compliant with antiretroviral therapy, presented (2007) with dysphagia and 32 kg-weight loss. EGD revealed a massive, cheesy, esophageal mucosal exudate from Candida albicans. Cytomegalovirus was isolated by viral culture. The patient improved after fluconazole/ganciclovir therapy. The patient re-presented (2019) with hematemesis and dysphagia. EGD revealed cheesy esophageal exudate and profound “punched out” esophageal ulcers mimicking pseudo-diverticula. Histopathology confirmed candidiasis. Viral cultures revealed cytomegalovirus. Barium esophagram revealed deep esophageal ulcers/pseudo-diverticula. Repeat EGD 8 weeks later after ganciclovir/micafungin therapy revealed mostly healed lesions. This demonstrates that AIDS patients may have massive mucosal esophageal candidiasis; that both infections can recur years after apparent eradication; and that cytomegaloviral esophageal ulcers may be profound and mimic pseudo-diverticula. A comprehensive literature review revealed only one abstract of esophageal pseudo-diverticula associated with cytomegalovirus. Simultaneous esophageal candidial and CMV infections have also been rarely reported in immunocompromised patients without AIDS.
Highlights
Immunocompromised patients with acquired immunodeficiency syndrome (AIDS) can develop opportunistic esophageal candidial and cytomegaloviral (CMV) infections
Hematoxylin-eosin stain of esophageal biopsies revealed insufficiently deep samples to histologically demonstrate CMV, but CMV was isolated by viral culture of esophageal biopsies. e patient improved after intravenous fluconazole and ganciclovir therapy
A comprehensive literature review revealed one prior report of esophageal deep ulcers that resembled esophageal pseudo-diverticula associated with CMV [4]
Summary
Immunocompromised patients with acquired immunodeficiency syndrome (AIDS) can develop opportunistic esophageal candidial and cytomegaloviral (CMV) infections. A case is reported which extends the spectrum of clinical, endoscopic, radiologic, and pathologic severity of these infections associated with AIDS by reporting (1)-simultaneous massive esophageal mucosal candidiasis and CMV; (2)-recurrence of both infections 12 years later; and (3)-occurrence of CMV “punched out” ulcers so deep that they mimicked esophageal “pseudo-diverticula” at esophagogastroduodenoscopy (EGD) and barium esophagram. ese phenomena are attributed to the patient’s poor adherence to antiretroviral therapy
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