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CMV Esophagitis

CMV esophagitis is an infection of the esophagus by the Cytomegalovirus. Symptoms include Dysphagia, upper abdominal pain, diarrhea, nausea, vomiting, and sometimes Hematemesis.

This condition occurs in the setting of immunocompromised patients 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. Another significant segment of the population are immunocompromised through transplant surgery, Diabetes, or due to immunosuppressive medication. Diagnosis is done primarily by endoscopy with biopsy, as CMV Esophagitis has a distinctive pathology pattern.

Signs and Symptoms
Dysphagia: Difficulty or pain while swallowing

Hematemesis:

Abdominal Pain: Pain in the upper abdominal area, usually exacerbated by swallowing. Pain can also manifest as heartburn symptoms

Nausea/vomiting

Fever

Diarrhea

Transmission
Parent to Child Transmission:

CMV that’s transmitted from mother’s to infants is a common form of the virus

Child to Child:

CMV transmission is uncommon between saliva, tears or skin contact

Adult Transmission:

CMV can be transmitted through blood contact or sex. Or if the infection is latent it can become reactivated

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 large cells in the subepithelial layer with inclusions within the cell’s nucleus and its cytoplasm. In addition to the histological examination fluorescent staining with an immunoperoxidase stain is highly specific. Radiologic imaging techniques are not effective in diagnosing CMV Esophagitis but can identify any resulting strictures or fistulas.

Pathology
Marcoscopy

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 cells are common on microscopic examination.

Treatment
Treatment revolves around intravenous treatment of Ganciclovir. Alternate treatments involve Valganciclovir, Cidofovir or Foscarnet. All of these medication can cause nausea, diarrhea, fever, loss of appetite. Rarer side effects include anemia and tremors.