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Case Reports
. 2012 Jul 5:2012:bcr2012006235.
doi: 10.1136/bcr-2012-006235.

Cytomegalovirus oesophagitis following treatment with fludarabine for refractory lymphoplasmacytic lymphoma

Nicola Pyatt  1 , Subir Mitra
Affiliations
Case Reports

Cytomegalovirus oesophagitis following treatment with fludarabine for refractory lymphoplasmacytic lymphoma

Nicola Pyatt et al. BMJ Case Rep. .

Abstract

A 64-year-old man with a 2-week history of fatigue and fever presented to the medical admissions unit. He had a background of lymphoplasmacytic lymphoma and had recently completed a course of fludarabine-based chemotherapy. CT of the abdomen demonstrated an increase in spleen size and it was thought that his fevers were most likely due to disease recurrence or high-grade transformation. A bone marrow trephine was organised, which showed no evidence of lymphoma and positron emission tomography-CT demonstrated an area of increased avidity at the gastro-oesophageal junction. An oesophagogastroduodenoscopy was recommended, which revealed ulceration within the oesophagus and stomach. Biopsy of the lesions and immunohistochemistry confirmed a diagnosis of cytomegalovirus oesophagitis. He was treated with intravenous ganciclovir followed by oral valganciclovir for a total of 3 weeks. His fever resolved and he was discharged home approximately 8 weeks after he first presented.

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Conflict of interest statement

Competing interests: None.

Figures

Figure 1
Figure 1
Positron emission tomography-CT scan: no evidence of high-grade transformation. A focal area of increased avidity at the gastro-oesophageal junction.
Figure 2
Figure 2
Oesophagogastroduodenoscopy demonstrating ulceration within the oesophagus.
Figure 3
Figure 3
Oesophagogastroduodenoscopy biopsy: oesophageal squamous epithelium with ulceration and subepithelial inflammation.
Figure 4
Figure 4
High-power views of oesophagogastroduodenoscopy biopsy showing inclusion body, with positive staining using immunohistochemistry with mouse monoclonal antibodies to cytomegalovirus.
See this image and copyright information in PMC

References

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