Endoscopy of Infectious Esophagitis

Endoscopy shows large ulcers of the esophagus Esophagitis is the second most common gastrointestinal (GI) manifestation of cytomegalovirus (CMV) infection after colitis. CMV esophagitis has been reported in patients who have undergone transplantation, patients undergoing long-term renal dialysis, patients with human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS), and patients with other debilitating diseases. CMV GI disease was first described in the 1960s. The average time to development of CMV esophagitis after solid organ transplantation is 5-7 months. Patients undergoing bone marrow transplantation may develop CMV disease much earlier, at an average of 2-3 months with symptoms occurring as early as 10 days after allogenic bone marrow transplantation. Patients with CMV esophagitis may have superimposed CMV colitis (in which case, care at a skilled nursing facility may be necessary). Patients with HIV infection are at increased risk because their CD4+ lymphocyte counts fall to less than 100 cells/µL. In patients with HIV infection or AIDS, CMV infection is an opportunistic infection that signals a decline in patient immunity. CMV esophagitis has been described in only 3 patients who had been immunocompromised by conditions other than transplantation, HIV infection, or AIDS. No cases have been reported in healthy hosts.