Esophageal Stricture Caused by Cytomegalovirus in a Renal Transplant Patient Not Infected by Human Immune Deficiency Virus

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Conference Proceeding

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American Journal of Gastroenterology


Introduction: Esophageal stricture due to cytomegalovirus infection (CMV) is an uncommon pathology, with most reported cases occurring in patients with Acquired Immunodeficiency Syndrome (AIDS). We are reporting the first case of esophageal stricture due to CMV esophagitis in a renal transplant patient without Human Immunodeficiency Virus (HIV). Case Description/Methods: A 77-year-old African American male who received a complex sequential deceased-donor (DCD) kidney transplant (CMV D1/R1) 2 years prior, presented with dysphagia and unintentional weight loss. He had progressive dysphagia for 4 months, initially for solids, then for thin liquids without odynophagia. His medications included omeprazole, mycophenolate, tacrolimus and prednisone. No history of caustic ingestion or radiation. The CMV and HIV test prior to admission was unremarkable. Barium swallow showed a 5cm segment of severe narrowing involving the distal esophagus. A computed tomography of the chest, abdomen and pelvis showed markedly dilated esophagus with probable stricture proximal to the gastroesophageal junction. Esophagogastroduodenoscopy demonstrated severe distal esophageal stricture with nearcomplete luminal obstruction suggestive of malignancy. However, the biopsy was negative for malignancy, HSV ½, HHV8, adenovirus, fungal stains but positive for CMV. He responded with ganciclovir/valacyclovir and serial esophageal dilatation with no residual dysphagia. Discussion: CMV infection is a common complication in transplant recipients. To our knowledge, this is the second to report the CMV esophagitis in a non-HIV patient and the first to report it in a renal transplant recipient. The endoscopic findings were not typical for CMV esophagitis (linear ulcers, erosions and mucosal haemorrhage in mid to distal esophagus), rather had mild stasis esophagitis and a 5 mm lesion at 32 mm with signs of tissue necrosis. This stresses the importance of diagnosis through histologic examination of biopsies with adequate sampling. Thus, an esophageal stricture in an immunocompromised individual should raise the suspicion of CMV.





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