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Iwata F, Fukui S, Okada M. Herpes Esophagitis Occurring after Immunosuppression with Glucocorticoids. Intern Med 2024; 63:1033-1034. [PMID: 37558476 PMCID: PMC11045390 DOI: 10.2169/internalmedicine.2259-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/03/2023] [Indexed: 08/11/2023] Open
Affiliation(s)
- Futoshi Iwata
- Immuno-Rheumatology Center, St. Luke's International Hospital, St. Luke's International University, Japan
| | - Sho Fukui
- Immuno-Rheumatology Center, St. Luke's International Hospital, St. Luke's International University, Japan
- Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, USA
- Department of Emergency and General Medicine, Kyorin University School of Medicine, Japan
| | - Masato Okada
- Immuno-Rheumatology Center, St. Luke's International Hospital, St. Luke's International University, Japan
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Risk Factors, Clinical and Endoscopic Features, and Clinical Outcomes in Patients with Cytomegalovirus Esophagitis. J Clin Med 2022; 11:jcm11061583. [PMID: 35329909 PMCID: PMC8955160 DOI: 10.3390/jcm11061583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/01/2022] [Accepted: 03/09/2022] [Indexed: 02/04/2023] Open
Abstract
Cytomegalovirus (CMV) esophagitis is the second most common CMV disease of the gastrointestinal tract. This study aims to comprehensively analyze risk factors, clinical characteristics, endoscopic features, outcomes, and prognostic factors of CMV esophagitis. We retrospectively collected data of patients who underwent esophageal CMV immunohistochemistry (IHC) staining between January 2003 and April 2021 from the pathology database at the Chang Gung Memorial Hospital. Patients were divided into the CMV and non-CMV groups according to the IHC staining results. We enrolled 148 patients (44 CMV and 104 non-CMV patients). The risk factors for CMV esophagitis were male sex, immunocompromised status, and critical illness. The major clinical presentations of CMV esophagitis included epigastric pain (40.9%), fever (36.4%), odynophagia (31.8%), dysphagia (29.5%), and gastrointestinal bleeding (29.5%). Multiple diffuse variable esophageal ulcers were the most common endoscopic feature. The CMV group had a significantly higher in-hospital mortality rate (18.2% vs. 0%; p < 0.001), higher overall mortality rate (52.3% vs. 14.4%; p < 0.001), and longer admission duration (median, 24 days (interquartile range (IQR), 11−47 days) vs. 14 days (IQR, 7−24 days); p = 0.015) than the non-CMV group. Acute kidney injury (odds ratio (OR), 174.15; 95% confidence interval (CI), 1.27−23,836.21; p = 0.040) and intensive care unit admission (OR, 26.53; 95% CI 1.06−665.08; p = 0.046) were predictors of in-hospital mortality. In conclusion, the mortality rate of patients with CMV esophagitis was high. Physicians should be aware of the clinical and endoscopic characteristics of CMV esophagitis in high-risk patients for early diagnosis and treatment.
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Rajasekaran V, Rahaman V, Hou X, Steele RW. HSV Esophagitis in an Immunocompetent 17-Year-Old. Glob Pediatr Health 2021; 8:2333794X211052914. [PMID: 34841008 PMCID: PMC8613879 DOI: 10.1177/2333794x211052914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Abstract
Herpes Simplex Virus (HSV) esophagitis is a relatively rare form of infectious esophagitis. Typically, patients with viral esophagitis are immunocompromised. HSV esophagitis in an immunocompetent patient is uncommonly reported. The objective of this case report is to discuss symptoms, investigations, imaging, and treatment of HSV esophagitis in a healthy adolescent male. A previously healthy 17-year-old male presented to the ED of our facility with a 5-day history of fever, odynophagia, lethargy, and 2 episodes of emesis that failed to resolve with antibiotic treatment. Investigations revealed a low platelet count, mild hyponatremia, hypochloremia, and an elevated AST and ALT. A respiratory infection panel as well as CMV IgG, HIV, Rickettsia, and EBV tests were negative. HSV-1 PCR was positive and upper endoscopy revealed a friable mucosa, erythema, and exudates in the lower esophagus and erythematous duodenopathy. The patient received a diagnosis of HSV esophagitis and was treated with a 14-day course of IV to PO acyclovir. There was a rapid improvement of his symptoms with antiviral therapy.
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Affiliation(s)
- Vedika Rajasekaran
- University of Queensland School of Medicine and Ochsner Clinical School, New Orleans, LA, USA
| | - Victoria Rahaman
- University of Queensland School of Medicine and Ochsner Clinical School, New Orleans, LA, USA
| | - Xing Hou
- University of Queensland School of Medicine and Ochsner Clinical School, New Orleans, LA, USA
| | - Russell W Steele
- University of Queensland School of Medicine and Ochsner Clinical School, New Orleans, LA, USA
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Saliba N, Au M, Apostolov R. Odynophagia in an Immunocompromised Patient. Am J Med Sci 2021; 363:e7. [PMID: 34666064 DOI: 10.1016/j.amjms.2021.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 02/13/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022]
Abstract
Our article presents a case of Herpes Simplex esophagitis in an immunocompromised patient who presented with severe odynophagia on a background of Metastatic Merkel Cell Carcinoma. Our patient's clinical history and examination findings initially suggest a likely fungal etiology for esophagitis, however as the case develops the diagnosis of Herpes Simplex esophagitis becomes more evident. Our case highlights common endoscopic and histological abnormalities seen in Herpes Simplex esophagitis. Our discussion elaborates on these abnormalities and reminds readers of the treatment for HSV esophagitis.
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Affiliation(s)
- Nadia Saliba
- Department of Gastroenterology, Eastern Health, Box Hill Hospital, Victoria, Australia.
| | - Minnie Au
- Department of Gastroenterology, Eastern Health, Box Hill Hospital, Victoria, Australia
| | - Ross Apostolov
- Department of Gastroenterology, Eastern Health, Box Hill Hospital, Victoria, Australia
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Kataria R, D'Cruze L, Lal T, Senthil N, Sundaram S. An Unusual Presentation of Herpes Esophagitis in an Immunocompromised Individual. Cureus 2021; 13:e15635. [PMID: 34306847 PMCID: PMC8278358 DOI: 10.7759/cureus.15635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/05/2022] Open
Abstract
Herpes simplex infection remains the third most common cause of esophagitis following gastric reflux disease and candida infection. This disease usually occurs in immunocompromised individuals; however, it has been frequently reported in healthy individuals. We present a case of a 39-year-old man who presented to the ER with symptoms unusual of herpes esophagitis. He was presumed to be immunocompromised due to uncontrolled diabetes mellitus and chronic alcohol use. Endoscopy revealed features in favor of candidiasis; however, histopathology displayed characteristic features of herpes infection. Herpes esophagitis should thus be suspected in immunocompromised patients with an independent underlying pathology and treated early with antiviral agents like acyclovir to prevent impending complications.
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Affiliation(s)
- Riya Kataria
- Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Lawrence D'Cruze
- Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Tusharindra Lal
- Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - N Senthil
- Internal Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Sandhya Sundaram
- Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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Machine learning approach for differentiating cytomegalovirus esophagitis from herpes simplex virus esophagitis. Sci Rep 2021; 11:3672. [PMID: 33574361 PMCID: PMC7878749 DOI: 10.1038/s41598-020-78556-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/17/2020] [Indexed: 11/08/2022] Open
Abstract
The endoscopic features between herpes simplex virus (HSV) and cytomegalovirus (CMV) esophagitis overlap significantly, and hence the differential diagnosis between HSV and CMV esophagitis is sometimes difficult. Therefore, we developed a machine-learning-based classifier to discriminate between CMV and HSV esophagitis. We analyzed 87 patients with HSV esophagitis and 63 patients with CMV esophagitis and developed a machine-learning-based artificial intelligence (AI) system using a total of 666 endoscopic images with HSV esophagitis and 416 endoscopic images with CMV esophagitis. In the five repeated five-fold cross-validations based on the hue-saturation-brightness color model, logistic regression with a least absolute shrinkage and selection operation showed the best performance (sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and area under the receiver operating characteristic curve: 100%, 100%, 100%, 100%, 100%, and 1.0, respectively). Previous history of transplantation was included in classifiers as a clinical factor; the lower the performance of these classifiers, the greater the effect of including this clinical factor. Our machine-learning-based AI system for differential diagnosis between HSV and CMV esophagitis showed high accuracy, which could help clinicians with diagnoses.
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Panarelli NC. Infectious diseases of the upper gastrointestinal tract. Histopathology 2020; 78:70-87. [PMID: 33382485 DOI: 10.1111/his.14243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/10/2020] [Accepted: 08/19/2020] [Indexed: 12/18/2022]
Abstract
A broad spectrum of pathogens produce gastrointestinal disease. The ongoing spread of human immunodeficiency virus/acquired immune deficiency syndrome, the increased use of immunosuppressive therapy and the persistence of overcrowding and suboptimal sanitation in underdeveloped areas facilitate both disease transmission from environmental and foodborne sources and person-to-person transmission. Clinicians increasingly rely on endoscopic biopsy sample interpretation to diagnose gastrointestinal infections. Thus, pathologists must be aware of diagnostic features of a variety of microbial pathogens. Detection with molecular techniques also allows for correlation between infectious agents and their histopathological features, which has expanded our knowledge of the inflammatory changes produced by infectious agents. This review covers infectious disorders of the upper gastrointestinal tract encountered in surgical pathology. Clinical, endoscopic and pathological features are presented. The review emphasises morphological features of viruses, bacteria, fungi and parasites that may be found in tissue samples, and the inflammatory patterns that they produce. Differential diagnoses and useful ancillary techniques are discussed.
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Li X, Huang S, Lu J, Lai R, Zhang Z, Lin X, Zheng X, Shan H. Upper Gastrointestinal Bleeding Caused by SARS-CoV-2 Infection. Am J Gastroenterol 2020; 115:1541-1542. [PMID: 32694288 PMCID: PMC7396212 DOI: 10.14309/ajg.0000000000000757] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Xiaofeng Li
- Department of Gastroenterology, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Siwen Huang
- Department of Gastroenterology, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Jing Lu
- Department of Gastroenterology, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Renxu Lai
- Department of Gastroenterology, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Zhenyi Zhang
- Department of Gastroenterology, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Xianqi Lin
- Department of Gastroenterology, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Xiaobin Zheng
- Department of Respiratory, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Hong Shan
- Guangdong Provincial Key Laboratory of Biomedical Imaging, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China;
- Guangdong Provincial Engineering Research Center of Molecular Imaging, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China
- Department of Interventional Medicine, the Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, China.
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Multiple esophageal ulcers due to tofacitinib 10 mg twice daily for ulcerative colitis. Clin J Gastroenterol 2019; 13:340-343. [PMID: 31705375 DOI: 10.1007/s12328-019-01061-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 10/24/2019] [Indexed: 10/25/2022]
Abstract
A 26-year-old man was admitted to our institution for ulcerative colitis treatment. He used mesalamine, steroid, immunomodulators, and anti-TNFα anti-body, but it was difficult to maintain remission. We started induction therapy with tofacitinib (TOF) 10 mg twice daily. He maintained clinical remission but had chest pain 44 days after the start of TOF. Esophagogastroduodenoscopy showed multiple ulcers from middle to lower esophagus. Although rare, TOF induced esophageal ulcers were considered based on his clinical course and endoscopic findings.
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