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. 2017 Nov;24(6):262-268.
doi: 10.1159/000479232. Epub 2017 Sep 2.

Cytomegalovirus Disease of the Upper Gastrointestinal Tract: A 10-Year Retrospective Study

Susana Marques  1 , Joana Carmo  1 , Daniel Pinto  2 , Miguel Bispo  1 , Sância Ramos  2 , Cristina Chagas  1
Affiliations

Cytomegalovirus Disease of the Upper Gastrointestinal Tract: A 10-Year Retrospective Study

Susana Marques et al. GE Port J Gastroenterol. 2017 Nov.

Abstract
in English, Portuguese

Background and aims: Cytomegalovirus (CMV) disease of the gastrointestinal (GI) tract is a major cause of morbidity and mortality in immunocompromised patients. The colon is the most commonly affected site, and the literature is scarce regarding CMV disease of the upper GI tract. Therefore, our study aimed to evaluate the clinical and endoscopic features of upper GI CMV disease.

Methods: This 10-year retrospective study included all patients with a histopathological diagnosis of upper GI CMV infection. Patients' clinical, endoscopic, therapy, and follow-up data were collected from medical records.

Results: Twelve patients with histopathologically proven upper GI CMV disease were identified (age 61 ± 18 years, 50% men). Most of the patients were immunocompromised (75%) due to acquired immunodeficiency syndrome (AIDS), malignancy, and/or immunosuppressive therapy. In the remainder (25%), the disease occurred in the absence of immunodeficiency and immunosuppression. Three patients (all with AIDS) presented with disseminated CMV infection. In the majority of the cases (83%), upper GI CMV disease was symptomatic, and the most common clinical presentations were odynophagia/dysphagia (25%) and nausea/vomiting (25%). Endoscopically, there were 5 cases of esophagitis (42%) and 7 cases of gastritis (58%). The lower esophagus (33%) and the gastric antrum (42%) were the most frequently affected GI sites. Regardless of the location, mucosal ulceration was the most common endoscopic finding (75%) and was associated with very deep ulceration resembling cavitation in 2 cases. Other endoscopic features were mucosal edema, hyperemia, and nodularity (25%). Eleven patients (92%) received antiviral treatment (duration 26 ± 12 days). The 1-month and 1-year mortality rates were 16.7 and 25%, respectively.

Conclusions: Upper GI CMV disease can occur in the absence of immunodeficiency and immunosuppression. It is usually symptomatic, and mucosal ulceration is often evident at endoscopy. It is associated with significant mortality; therefore, early diagnosis and adequate antiviral treatment are essential.

Introdução: A doença gastrointestinal (GI) por Citomegalovírus (CMV) é uma causa importante de morbilidade e mortalidade em doentes imunocomprometidos. O cólon é o local mais comummente afectado e a literatura é escassa em relação à doença por CMV do tracto GI alto. Dessa forma, o nosso estudo teve como objectivo avaliar as características clínicas e endoscópicas da doença por CMV do tracto GI alto.

Métodos: Trata-se de um estudo retrospectivo de 10 anos, que incluiu todos os doentes com o diagnóstico histopatológico de doença por CMV do tracto GI alto. Os dados clínicos, endoscópicos e sobre a terapêutica e o follow-up dos doentes foram obtidos por consulta de processos clínicos.

Resultados: Foram identificados 12 doentes com o diagnóstico histopatológico de doença por CMV do tracto GI alto (idade 61 ± 18 anos, 50% homens). A maioria dos doentes era imunocomprometida (75%) no contexto de síndrome de imunodeficiência adquirida (SIDA), malignidade e/ou terapêutica imunossupressora. Nos restantes doentes (25%), a doença ocorreu na ausência de imunodeficiência ou imunossupressão. Três doentes (todos com SIDA) apresentaram infecção por CMV disseminada. Na maioria dos casos (83%), a doença por CMV do tracto GI alto foi sintomática e as apresentações clínicas mais comuns foram odinofagia/disfagia (25%) e náuseas/vómitos (25%). Endoscopicamente, registaram-se 5 casos de esofagite (42%) e 7 casos de gastrite (58%). O esófago inferior (33%) e o antro gástrico (42%) foram os locais mais frequentemente envolvidos. Independentemente da localização, a ulceração da mucosa foi o achado endoscópico mais comum (75%) e associou-se a ulceração muito profunda semelhante a cavitação em 2 casos. Outros achados endoscópicos foram edema, hiperémia e nodularidade da mucosa (25%). Onze doentes (92%) receberam terapêutica antiviral (duração 26 ± 12 dias). As taxas de mortalidade a 1 mês e a 1 ano foram 16.7 e 25%, respectivamente.

Conclusões: A doença por CMV do tracto GI alto pode ocorrer na ausência de imunodeficiência e de imunossupressão. É geralmente sintomática e apresenta com frequência ulceração da mucosa na endoscopia. Associa-se a mortalidade significativa, pelo que o diagnóstico precoce e a instuição adequada de tratamento antiviral são essenciais.

Keywords: Cytomegalovirus; Endoscopy; Esophagitis; Gastritis.

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Figures

Fig. 1
Fig. 1
Histopathological images of upper gastrointestinal cytomegalovirus (CMV) disease (patient 6, biopsy specimen of a gastric ulcer). a Histological detection of CMV inclusion bodies (arrow). Hematoxylin and eosin. ×400. b Positive CMV immunohistochemistry (arrows). ×400.
Fig. 2
Fig. 2
Endoscopic images of upper gastrointestinal cytomegalovirus disease. a Deep esophageal ulcers (patient 4). b Deep ulcers in the gastric antrum (patient 6). c Extensive ulceration of the gastric fundus (patient 10).
See this image and copyright information in PMC

References

    1. Wang HW, Kuo CJ, Lin WR, et al. The clinical characteristics and manifestations of cytomegalovirus esophagitis. Dis Esophagus. 2016;29:392–399. - PubMed
    1. Ozaki T, Yamashita H, Kaneko S, et al. Cytomegalovirus disease of the upper gastrointestinal tract in patients with rheumatic diseases: a case series and literature review. Clin Rheumatol. 2013;32:1683–1690. - PubMed
    1. Seo M, Kim do H, Gong EJ, et al. Is follow-up endoscopy necessary in upper gastrointestinal cytomegalovirus disease? Medicine (Baltimore) 2016;95:e3389. - PMC - PubMed
    1. Bonetti LR, Losi L, Greagorio C, et al. Cytomegalovirus infection of the upper gastrointestinal tract: a clinical and pathological study of 30 cases. Scand J Gastroenterol. 2011;46:1228–1235. - PubMed
    1. You DM, Johnson MD. Cytomegalovirus infection and the gastrointestinal tract. Curr Gastroenterol Rep. 2012;14:334–342. - PubMed