Año 2024 / Volumen 116 / Número 8
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A rare cause of severe esophagitis in an immunocompetent patient: double complication with an endoscopic resolution

446-447

DOI: 10.17235/reed.2023.9966/2023

Sofia Bragança, Filipa Bordalo Ferreira, Ana Maria Oliveira, Mariana Nuno Costa, David Horta,

Resumen
A 75-year-old male, without relevant medical history and negative HIV1/2 serology, presented at the emergency department with mixed shock (septic – from pleuroparenchymal origin – and hypovolemic due to upper gastrointestinal bleeding [UGIB]). Thoracoabdominal CT scan showed an esophagopleural fistula (EPF), with a large right pleural effusion (lately known to be compatible with exudate - Light's criteria) and right pneumothorax, without active bleeding. The upper gastrointestinal endoscopy (UGIE) showed a severe esophagitis and, in distal oesophagus, an ulcer with an orifice in the center. Biopsies of the edges of the ulcer were performed. Anatomopathological (AP) studies were negative for viral agents but tissue molecular studies (polymerase chain reaction [PCR]) identified cytomegalovirus (CMV) DNA. Despite no immunosuppression condition was identified, CMV severe esophagitis complicated by EPF with right-side empyema and UGIB was diagnosed. An oesophageal fully covered metal stent (FCMS), with anti-migration system, was left in place during 5-weeks and ganciclovir therapy (5mg/kg/day) was maintained for 21-days. Clinical-analytical, radiological and endoscopic improvement was noticed. No recurrence in the following year of follow-up.
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Bibliografía
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2. Bernard S, Germi R, Lupo J, et al. Symptomatic cytomegalovirus gastrointestinal infection with positive quantitative real-time PCR findings in apparently immunocompetent patients: A case series. Clinical Microbiology and Infection 2015;21:1121.e1-7. DOI: 10.1016/j.cmi.2015.05.016
3. Péter A, Telkes G, Varga M, et al. Endoscopic diagnosis of cytomegalovirus infection of upper gastrointestinal tract in solid organ transplant recipients: Hungarian single-center experience. Clin Transplant 2004;18: 580–4. DOI: 10.1111/j.1399-0012.2004.00230.x
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Instrucciones para citar
Bragança S, Bordalo Ferreira F, Oliveira A, Nuno Costa M, Horta D. A rare cause of severe esophagitis in an immunocompetent patient: double complication with an endoscopic resolution. 9966/2023


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Ficha Técnica

Recibido: 18/09/2023

Aceptado: 23/09/2023

Prepublicado: 26/10/2023

Publicado: 01/08/2024

Tiempo de prepublicación: 38 días

Tiempo de edición del artículo: 318 días


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