Corticosteroids
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CMV-associated oesophagitis: case report A 63-year-old man developed cytomegalovirus (CMV)associated oesophagitis during treatment with corticosteroids [specific drugs and dosages not stated]. The man presented with a massive chest pain and was hospitalised with a working hypothesis of myocardial infarction. He reported that his pain was directly related to the intake of food and drink, which resulted in a bolus feeding and a heartburn-like burning sensation. Because of a decreased food intake due to the discomfort, he had lost about 14kg of weight over about 6 weeks; he also had difficulty drinking fluids. In the previous months before hospitalisation, he had presented at his GP’s office with chronic obstructive pulmonary disease (COPD). On hospitalisation, he had signs of chronic bronchitis and a myocardial infarction was ruled out. Due to increasing odynophagia and chest pain, a gastroscopy was performed, which revealed a massive ulcerous oesophagitis with sprinkled whitish plaques. The man started receiving amphotericin B for potential Candida oesophagitis. However, biopsy findings from the ulcers and plaques ruled out a Candida infection; a herpes simplex virus oesophagitis was suspected. He started receiving IV aciclovir but, 7 days later, no healing was observed on gastroscopy. Repeat biopsies were taken and PCR tests were strongly positive for CMV, weakly positive for Epstein-Barr virus and negative for herpes simplex virus. He then started receiving ganciclovir and, 14 days later, his odynophagia and gastroscopy findings had improved. No more CMV DNA was seen in repeat biopsies and he was discharged. Further investigations revealed that he had previously received a short-term treatment with corticosteroids for COPD [duration of treatment to reaction onset not stated]. Author comment: "In our case, the described CMV esophagitis was highly related to the short-term treatment with corticosteroids by the family physician, a fact which was not reported when the patient presented at the [hospital]." Weile J, et al. Severe cytomegalovirus-associated esophagitis in an immunocompetent patient after short-term steroid therapy. Journal of Clinical 801154954 Microbiology 47: 3031-3033, No. 9, Sep 2009 - Germany
0114-9954/10/1283-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Reactions 9 Jan 2010 No. 1283
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