A case of cytomegalovirus esophagitis during topical steroid therapy for eosinophilic esophagitis
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CASE REPORT
A case of cytomegalovirus esophagitis during topical steroid therapy for eosinophilic esophagitis Ken Suzaki1 · Katsumasa Kobayashi1 · Mana Matsuoka1 · Yukito Okura1 · Takahito Nozaka1 · Masato Yauchi1 · Taro Watabe1 · Taichi Matsumoto1 · Yohei Furumoto1 · Takao Horiuchi1 · Toru Asano1 · Kazuhiko Fujiki1 Received: 7 March 2020 / Accepted: 24 August 2020 © Japanese Society of Gastroenterology 2020
Abstract Systemic immune deficiency is a major cause of cytomegalovirus (CMV) esophagitis. We report a case of CMV esophagitis during topical steroid therapy of eosinophilic esophagitis (EoE) in a non-immunodeficient patient. An 85-year-old man with dysphagia was on a 6-year regimen of oral budesonide (1200 mcg daily) for EoE. He underwent right upper lobectomy and postoperative radiotherapy 25 years ago for lung squamous cell carcinoma. Esophageal cicatricial stenosis due to EoE or previous radiation therapy persisted. Esophagogastroduodenoscopy revealed ulcerating mucosa with a thick white coat originating from the fixed stenotic lesion to the oral side. Histopathological examinations revealed CMV esophagitis. All signs of CMV esophagitis rapidly disappeared after reducing the budesonide dose and initiating anti-viral treatment with ganciclovir and valganciclovir for 12 and 2 days, respectively. The patient continued topical budesonide 400 mcg daily after anti-viral therapy. The clinical course was uneventful and without CMV esophagitis recurrence. This suggests that topical steroid therapy, particularly the local stasis of steroids at stenotic lesions, may induce CMV esophagitis. This is the first report of CMV esophagitis complicating the local steroid therapy of EoE with a stenotic lesion. When EoE patients’ clinical symptoms worsen with topical steroid therapy, CMV esophagitis should be considered. Keywords Cytomegalovirus esophagitis · Eosinophilic esophagitis · Topical steroid therapy · Esophageal stenosis
Introduction Cytomegalovirus (CMV) esophagitis is a common result of systemic immune deficiency, which can be caused by conditions such as human immunodeficiency virus (HIV) infection and can occur after treatments such as post-organ transplantation, long-term dialysis, and systemic steroid therapy [1–3]. In contrast, CMV esophagitis in patients without systemic immunodeficiency has not been well documented in the current literature. Recently, several studies have reported on CMV esophagitis occurring in immunocompetent patients, indicating its pervasive spread [2–5]. Nevertheless, the precise etiology remains elusive. Furthermore, there is no previous report of topical steroid therapy causing CMV esophagitis, especially in an esophageal stenotic * Katsumasa Kobayashi [email protected] 1
Department of Gastroenterology, Tokyo Metropolitan Bokutoh Hospital, 4‑23‑15, Kotobashi, Sumida‑ku, Tokyo 130‑8575, Japan
lesion. Here, we report an unusual case of CMV esophagitis during the application of topical steroid therapy for the treatment of eosinophilic esophagitis (EoE) in a patient without
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