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Philp HS, Johnson LR, Choi EA, Brosnan RJ, Slater RT. Feline herpesvirus-1-related multiple respiratory eosinophilic nodules in an adult cat receiving long-term oral prednisolone. JFMS Open Rep 2024; 10:20551169231220291. [PMID: 38299191 PMCID: PMC10829494 DOI: 10.1177/20551169231220291] [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] [Indexed: 02/02/2024] Open
Abstract
Case summary A 10-year-old male castrated domestic shorthair cat was presented for evaluation of a 3-day history of increased inspiratory effort. The cat had received prednisolone 1 mg/kg PO q24h for 1 year due to chronic diarrhea. On physical examination, the patient exhibited severe stridor, intermittent open-mouth breathing and bilateral mucopurulent nasal discharge. Subcutaneous emphysema was palpated over the dorsal cervical region. Mild hypoventilation (PvCO2 55.1 mmHg; approximate reference interval 35-45 mmHg) was identified. Cervicothoracic radiographs showed marked gas tracking within cervical soft tissues with concurrent laryngeal thickening, pulmonary nodules, a bronchial pulmonary pattern, pneumomediastinum and aerophagia. The cat was hospitalized and treated overnight with oxygen and intravenous fluid therapy before anesthesia the next day. On laryngoscopy, a large tracheal mass was observed arising from the right subglottic region and was removed using biopsy forceps. CT revealed an additional mass at the level of the tracheal bifurcation causing marked luminal narrowing of the trachea and proximal main bronchi. The cat made a good initial recovery, although moderate stridor persisted. Five days later, the cat was re-examined due to recurrence of respiratory distress and orthopnea, and the owner elected euthanasia. Histopathology revealed severe nodular obstructive eosinophilic plasmacytic laryngotracheitis with intranuclear inclusion bodies positive for feline herpesvirus-1 on immunohistochemistry. Relevance and novel information This report describes the presentation and management of a cat with respiratory distress secondary to intratracheal eosinophilic masses caused by feline herpesvirus-1. Although the outcome was ultimately unsatisfactory, to the authors' knowledge, this clinical presentation has not been previously reported.
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Affiliation(s)
- Helen S Philp
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California Davis, Davis, CA, USA
| | - Lynelle R Johnson
- Department of Medicine & Epidemiology, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Eunju April Choi
- Department of Pathology, Microbiology & Immunology, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Robert J Brosnan
- Department of Surgical & Radiological Sciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Robert T Slater
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California Davis, Davis, CA, USA
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Patel H, Nguyen SMT, Haque A, Krishnaswamy G. Odynophagia in a young adult: revisiting herpetic esophagitis and eosinophilic esophagitis. BMJ Case Rep 2022; 15:e251238. [PMID: 36368731 PMCID: PMC9660505 DOI: 10.1136/bcr-2022-251238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
An immunocompetent man in his 20s presented with a 24-hour history of severe odynophagia, nausea, vomiting and throat pain. Esophagogastroduodenoscopy (EGD) revealed severe esophagitis with ulcerated mucosa, exudative debris, haemorrhage and multiple erosions. Biopsy of the oesophageal tissue demonstrated marginated chromatin, multinucleated giant cells and molding of nuclei, consistent with herpes simplex virus esophagitis (HSE). Treatment with oral acyclovir led to the complete resolution of symptoms. The patient subsequently developed dysphagia again, 8 months later. EGD showed furrowing and concentric rings typical of eosinophilic esophagitis (EoE), a diagnosis confirmed by biopsy. Treatment with a proton pump inhibitor and swallowed topical corticosteroids led to symptomatic improvement. Thus, HSE can occur in immunocompetent hosts and on occasion, HSE may be a harbinger of EoE, as evidenced by our extensive literature review. Mechanical disruption of the mucosal barrier by viruses, facilitating food allergen penetration, and associated immunological signaling abnormalities may be responsible phenomena requiring further elucidation.
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Affiliation(s)
- Hiral Patel
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Aaisha Haque
- Allergy, Asthma and Clinical Immunology, Salisbury VA Medical Center, Salisbury, North Carolina, USA
| | - Guha Krishnaswamy
- Allergy, Asthma and Clinical Immunology, Salisbury VA Medical Center, Salisbury, North Carolina, USA
- Department of Medicine, Section on Pulmonary, Critical Care, Allergy and Clinical Immunology, Section on Infectious Disease, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Quera R, Sassaki LY, Núñez P, Contreras L, Bay C, Flores L. Herpetic Esophagitis and Eosinophilic Esophagitis: A Potential Association. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933565. [PMID: 34565790 PMCID: PMC8486434 DOI: 10.12659/ajcr.933565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease, infectious esophagitis, and eosinophilic esophagitis are the most frequent causes of esophagitis, the latter 2 etiologies being generally considered independently. However, the association between both entities has been suggested through case reports in immunocompetent patients. CASE REPORT We present the case of an immunocompetent 26-year-old man presenting with fever, adynamia, retrosternal pain, and dysphagia. Endoscopy was performed, showing whitish lesions in circular plates with erosions, and in some depressed areas in the middle and distal esophagus. Biopsies showed the presence of ulcerated foci covered by fibrinoleukocyte exudate in granulation tissue and nuclear inclusions with a viral appearance. The immunohistochemical study for herpes simplex virus (HSV) was positive. The patient was treated symptomatically and progressed favorably. The endoscopic control carried out at 3 months showed longitudinal grooves and trachealization, findings compatible with the diagnosis of eosinophilic esophagitis and with biopsies that confirmed the etiology by showing an increase in eosinophil count >20 per field, without isolating HSV. CONCLUSIONS This clinical case confirms the possible relationship between esophagitis caused by HSV and eosinophilic esophagitis. Alterations at the immune level and damage to the esophageal mucosa barrier may explain this relationship. In this scenario, an endoscopic follow-up should be considered.
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Affiliation(s)
- Rodrigo Quera
- Inflammatory Bowel Disease Program, Section of Gastroenterology. Digestive Disease Center, Clinica Universidad de los Andes, Santiago, Chile
- Corresponding Author: Rodrigo Quera, e-mail:
| | - Ligia Yukie Sassaki
- Department of Internal Medicine, São Paulo State University (UNESP), Medical School, Botucatu, SP, Brazil
| | - Paulina Núñez
- Inflammatory Bowel Disease Program, Section of Gastroenterology. Digestive Disease Center, Clinica Universidad de los Andes, Santiago, Chile
- Department of Gastroenterology, Hospital San Juan de Dios, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Luis Contreras
- Departament of Pathological Anatomy, Clinica Universidad de los Andes, Santiago, Chile
| | - Constanza Bay
- Department of Pediatrics, Faculty of Medicine, Pontifica Universidad Catòlica, Santiago, Chile
| | - Lilian Flores
- Inflammatory Bowel Disease Program, Section of Gastroenterology. Digestive Disease Center, Clinica Universidad de los Andes, Santiago, Chile
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Ghoddoosi M, Jazi K, Hajrezaei Z, Habibi MA, Ahmadpour S, Pezeshki Modares M. UPPER GASTROINTESTINAL BLEEDING DUE TO CONCOMITANT ESOPHAGEAL VARICES AND HERPES SIMPLEX VIRUS ESOPHAGITIS IN A 70-YEAR-OLD PATIENT. Gastroenterol Nurs 2021; 44:357-360. [PMID: 34269710 DOI: 10.1097/sga.0000000000000598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 01/19/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Mahdieh Ghoddoosi
- Mahdieh Ghoddoosi, PhD, MD, is Assistant Professor of Pathology, Department of Pathology, Shahid Beheshti Medical Centre, Qom University of Medical Sciences, Qom, Iran
- Kimia Jazi, MD, is Medical Doctor, Student Research Committee, Faculty of Medicine, Medical University of Qom, Qom, Iran
- Zahra Hajrezaei, MD, is Medical Doctor, Student Research Committee, Faculty of Medicine, Medical University of Qom, Qom, Iran
- Mohammad Amin Habibi, MD, is Medical Doctor, Student Research Committee, Faculty of Medicine, Medical University of Qom, Qom, Iran
- Sajjad Ahmadpour, PhD, MSc, is Assistant Professor of Nuclear Pharmacy, Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
- Mahdi Pezeshki Modares, PhD, MD, is Assistant Professor of Gastroenterology and Hepatology, Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Kimia Jazi
- Mahdieh Ghoddoosi, PhD, MD, is Assistant Professor of Pathology, Department of Pathology, Shahid Beheshti Medical Centre, Qom University of Medical Sciences, Qom, Iran
- Kimia Jazi, MD, is Medical Doctor, Student Research Committee, Faculty of Medicine, Medical University of Qom, Qom, Iran
- Zahra Hajrezaei, MD, is Medical Doctor, Student Research Committee, Faculty of Medicine, Medical University of Qom, Qom, Iran
- Mohammad Amin Habibi, MD, is Medical Doctor, Student Research Committee, Faculty of Medicine, Medical University of Qom, Qom, Iran
- Sajjad Ahmadpour, PhD, MSc, is Assistant Professor of Nuclear Pharmacy, Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
- Mahdi Pezeshki Modares, PhD, MD, is Assistant Professor of Gastroenterology and Hepatology, Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Zahra Hajrezaei
- Mahdieh Ghoddoosi, PhD, MD, is Assistant Professor of Pathology, Department of Pathology, Shahid Beheshti Medical Centre, Qom University of Medical Sciences, Qom, Iran
- Kimia Jazi, MD, is Medical Doctor, Student Research Committee, Faculty of Medicine, Medical University of Qom, Qom, Iran
- Zahra Hajrezaei, MD, is Medical Doctor, Student Research Committee, Faculty of Medicine, Medical University of Qom, Qom, Iran
- Mohammad Amin Habibi, MD, is Medical Doctor, Student Research Committee, Faculty of Medicine, Medical University of Qom, Qom, Iran
- Sajjad Ahmadpour, PhD, MSc, is Assistant Professor of Nuclear Pharmacy, Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
- Mahdi Pezeshki Modares, PhD, MD, is Assistant Professor of Gastroenterology and Hepatology, Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Mohammad Amin Habibi
- Mahdieh Ghoddoosi, PhD, MD, is Assistant Professor of Pathology, Department of Pathology, Shahid Beheshti Medical Centre, Qom University of Medical Sciences, Qom, Iran
- Kimia Jazi, MD, is Medical Doctor, Student Research Committee, Faculty of Medicine, Medical University of Qom, Qom, Iran
- Zahra Hajrezaei, MD, is Medical Doctor, Student Research Committee, Faculty of Medicine, Medical University of Qom, Qom, Iran
- Mohammad Amin Habibi, MD, is Medical Doctor, Student Research Committee, Faculty of Medicine, Medical University of Qom, Qom, Iran
- Sajjad Ahmadpour, PhD, MSc, is Assistant Professor of Nuclear Pharmacy, Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
- Mahdi Pezeshki Modares, PhD, MD, is Assistant Professor of Gastroenterology and Hepatology, Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Sajjad Ahmadpour
- Mahdieh Ghoddoosi, PhD, MD, is Assistant Professor of Pathology, Department of Pathology, Shahid Beheshti Medical Centre, Qom University of Medical Sciences, Qom, Iran
- Kimia Jazi, MD, is Medical Doctor, Student Research Committee, Faculty of Medicine, Medical University of Qom, Qom, Iran
- Zahra Hajrezaei, MD, is Medical Doctor, Student Research Committee, Faculty of Medicine, Medical University of Qom, Qom, Iran
- Mohammad Amin Habibi, MD, is Medical Doctor, Student Research Committee, Faculty of Medicine, Medical University of Qom, Qom, Iran
- Sajjad Ahmadpour, PhD, MSc, is Assistant Professor of Nuclear Pharmacy, Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
- Mahdi Pezeshki Modares, PhD, MD, is Assistant Professor of Gastroenterology and Hepatology, Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Mahdi Pezeshki Modares
- Mahdieh Ghoddoosi, PhD, MD, is Assistant Professor of Pathology, Department of Pathology, Shahid Beheshti Medical Centre, Qom University of Medical Sciences, Qom, Iran
- Kimia Jazi, MD, is Medical Doctor, Student Research Committee, Faculty of Medicine, Medical University of Qom, Qom, Iran
- Zahra Hajrezaei, MD, is Medical Doctor, Student Research Committee, Faculty of Medicine, Medical University of Qom, Qom, Iran
- Mohammad Amin Habibi, MD, is Medical Doctor, Student Research Committee, Faculty of Medicine, Medical University of Qom, Qom, Iran
- Sajjad Ahmadpour, PhD, MSc, is Assistant Professor of Nuclear Pharmacy, Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
- Mahdi Pezeshki Modares, PhD, MD, is Assistant Professor of Gastroenterology and Hepatology, Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
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Khan S, Guo X, Liu T, Iqbal M, Jiang K, Zhu L, Chen X, Wang BM. An Update on Eosinophilic Esophagitis: Etiological Factors, Coexisting Diseases, and Complications. Digestion 2021; 102:342-356. [PMID: 32570246 DOI: 10.1159/000508191] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/26/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Eosinophilic esophagitis (EoE) is an immune-mediated clinicopathological condition characterized by esophageal infiltration with eosinophils resulting in chronic inflammation and stricture. SUMMARY The recent increase in the incidence of EoE and the characteristic presentation of symptoms with difficulty swallowing and food bolus impaction has raised key concerns of clinicians as well as researchers. EoE often presents with dysphagia, food impaction, nausea, regurgitation or vomiting, and decreased appetite. It is more common in males, affecting both adults and children. The causative manner of this condition is complex and multifactorial. Throughout recent years, researchers have made a significant contribution to understanding the pathogenesis of EoE, genetic background, natural history, work on allergy, and standardization in the evaluation of disease activity. There is relatively high prevalence of EoE among the population, emphasizing the importance of this disease. Key messages: Esophageal involvement with eosinophils may be manifested as isolated or with coexisting conditions and should be taken into consideration in the differential diagnosis. This study aimed to provide gastroenterologists with novel insights into the evaluation of esophageal involvement with eosinophils and to pay special attention to the etiological factors, coexisting clinical diseases, and complications.
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Affiliation(s)
- Samiullah Khan
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaopei Guo
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Tianyu Liu
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Muhammad Iqbal
- Department of Otorhinolaryngology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Kui Jiang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Lanping Zhu
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xin Chen
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China
| | - Bang-Mao Wang
- Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, China,
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