RESUMEN
Gastroenterologists frequently perform endoscopic esophageal mucosal biopsies for pathologic diagnosis in patients experiencing symptoms of esophagitis. The more common causes of esophagitis diagnosed on esophageal mucosal biopsy include reflux esophagitis, eosinophilic esophagitis, and infectious esophagitis caused by Candida albicans, herpes simplex virus, and/or cytomegalovirus. However, there are several causes of esophagitis seen less frequently by pathologists that are very important to recognize. We discuss unique types of esophageal inflammation, including acute bacterial esophagitis, esophageal manifestations of dermatologic diseases, medication-induced esophageal injury, and sloughing esophagitis; and we review their clinical and histopathologic features.
Asunto(s)
Esofagitis Eosinofílica , Esofagitis Péptica , Esófago , Infecciones Bacterianas/metabolismo , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/patología , Infecciones Bacterianas/virología , Biopsia , Candida albicans/metabolismo , Candidiasis/metabolismo , Candidiasis/microbiología , Candidiasis/virología , Citomegalovirus/metabolismo , Infecciones por Citomegalovirus/metabolismo , Infecciones por Citomegalovirus/microbiología , Infecciones por Citomegalovirus/virología , Esofagitis Eosinofílica/metabolismo , Esofagitis Eosinofílica/microbiología , Esofagitis Eosinofílica/patología , Esofagitis Eosinofílica/virología , Esofagitis Péptica/metabolismo , Esofagitis Péptica/microbiología , Esofagitis Péptica/patología , Esofagitis Péptica/virología , Esofagoscopía , Esófago/metabolismo , Esófago/microbiología , Esófago/patología , Esófago/virología , Herpes Simple/metabolismo , Herpes Simple/microbiología , Herpes Simple/patología , Herpes Simple/virología , Humanos , Inflamación/metabolismo , Inflamación/microbiología , Inflamación/patología , Inflamación/virología , Simplexvirus/metabolismoRESUMEN
Cytomegalovirus (CMV) gastrointestinal disease usually arises in patients with immunodeficiency or immunosuppression, being rare in immunocompetent hosts. Although increasing in incidence, few cases of CMV gastrointestinal disease have been described among young healthy patients. Currently, there is uncertainty in approaching these patients, including the need for antiviral therapy that remains to be established. This case report describes a CMV ulcerative oesophagitis in a young healthy immunocompetent patient with good evolution with no need for antiviral therapy, the youngest case being reported in the literature until now.
Asunto(s)
Infecciones por Citomegalovirus/diagnóstico , Esofagitis Péptica/diagnóstico , Esofagitis Péptica/virología , Adulto , Citomegalovirus/aislamiento & purificación , Infecciones por Citomegalovirus/terapia , Esofagitis Péptica/terapia , Esofagoscopía , Femenino , Humanos , Inmunocompetencia , Inhibidores de la Bomba de Protones/uso terapéuticoRESUMEN
OBJECTIVE: To determine the aetiology of oesophageal ulceration in HIV-infected patients. DESIGN: A retrospective clinical, endoscopic and histopathological analysis of patients with confirmed HIV infection and an oesophageal ulcer diagnosed on endoscopy. SETTING: A tertiary referral, gastrointestinal clinic in Cape Town. RESULTS: Fifty-one patients with HIV infection and oesophageal ulceration were seen from January 2001 to December 2007. Median CD4 count was 26 cells/microl. Mean age was 35.5 years. Sixty per cent of patients were female. Forty-nine per cent of oesophageal ulcers were idiopathic while 23% were caused by cytomegalovirus infection. The remainder were due to miscellaneous causes. CONCLUSION: A surprisingly small number of patients with HIV-associated oesophageal ulceration were seen during the study period. This may reflect local referral practices or the fact that patients with severe immunosuppression succumb before developing oesophageal ulcers. As in other series, idiopathic oesophageal ulcers and cytomegalovirus ulcers made up the majority of cases. Correct biopsy technique and appropriate histological and microbiological investigations are associated with improved diagnostic yield in these patients.
