A CASE OF CYTOMEGALOVIRUS ESOPHAGITIS

Abstract

A 22-year-old male was admitted to Kitasato University Hospital because of paralytic ileus due to SLE. One month after admission, he complained of severe odynophagia and poststernal pain, while treated with predonisolone. The endoscopy on 25th hospital day revealed multiple erosive lesions with raised, overhanging edges in the mid-lower esophagus. Biopsies of the erosive lesions revealed cytomegalic inclusions in nuclei and cytoplasm, mainly of vascular lining cells. An immunofluorescent study of the biopsied specimens disclosed cytomegalovirus (CMV) antigen in inclusions. We suspected that the etiology of esophagitis was ischemia due to vasculitis induced by CMV infection. Many postmortem cases of CMV esophagitis have been reported, endoscopically diagnosed cases are as few as 18 cases in European countries and 2 cases in Japan.