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Indian Journal of Medical Microbiology, Vol. 26, No. 1, January-March, 2008, pp. 79-80 Case Report Cytomegalovirus oesophagitis in a patient with non-hodgkin's lymphoma Hingmire SS, Biswas G, Bakshi A, Desai S, Dighe S, Nair R, Gupta S, Parikh PM Department of Medical Oncology, Tata Memorial Hospital, Mumbai - 400 012, Maharashtra Date of Submission: 02-Oct-2005 Code Number: mb08018 Abstract Cytomegalovirus (CMV) infection is frequent in immunocompromised patients, especially in AIDS, organ transplantation and rarely in Hodgkin's disease and Non-Hodgkin's lymphoma (NHL). We present a case of NHL with CMV oesophagitis, which has rarely been documented in literature. Apart from fungal and herpes simplex infections, as the common differential diagnosis for oesophagitis in patients of lymphoma, CMV should be considered an important etiologic agent. Early diagnosis and prompt treatment of CMV oesophagitis with gancyclovir can avert significant morbidity and avoid unacceptable treatment delays.Keywords: Cytomegalovirus, non-Hodgkin′s lymphoma, oesophagitis Cell-mediated immunity is altered in patients of lymphoma. Cytomegalovirus (CMV) infections are less common and not frequently reported in patients of Hodgkin′s disease (HD) and Non-Hodgkin′s lymphoma (NHL). [1] Among CMV infections in patients of lymphoma, CMV pneumonias are the most common. We report a case of oesophageal CMV in a case of NHL, which was treated successfully with gancyclovir. Case Report A 50-year-old male patient, HIV seronegative, symptomatic with fever for 8 months and significant weight loss, was found to have mediastinal, retroperitoneal, para-aortic, left axillary and right supraclavicular lymphadinopathy. Biopsy of the right supraclavicular lymph node was consistent with the diagnosis of T cell rich, B cell high-grade NHL. Subsequent to three cycles of chemotherapy, the patient developed non-neutropenic fever, associated with severe dysphagia, persistent retrosternal pain and reduced oral intake. Oesophagoscopic examination revealed extensive superficial ulceration with erythematous nodules. Cytologic examination of oesophageal brushings showed squamous cells with large intra-nuclear basophilic inclusions with a distinct halo around it. These inclusion bodies in epithelial cells were diagnostic of CMV [Figure - 1]. CMV DNA positivity in blood by hybrid capture assay confirmed the diagnosis of CMV oesophagitis. Gancyclovir in a dose of 5 mg/kg was given per oral for 21 days, following which the patient showed symptomatic relief, with resolution of oesophageal lesions on upper gastrointestinal endoscopic examination and negative CMV DNA assay. Discussion CMV is a herpes virus, which causes a latent, asymptomatic infection. Symptomatic CMV infection occurs with suppression of cellular immunity. Both reactivation and primary infections are common in organ transplantation and AIDS. CMV is the most common viral pathogen complicating organ transplantation. Kidney, liver, heart and bone marrow transplant recipients are at very high risk of CMV infections. CMV is an important pathogen in AIDS, almost universal in these patients. Cell-mediated immunity is altered in patients of lymphoma. CMV infections are less common and not frequently reported in patients of HD and NHL. Among CMV infections in patients of lymphoma, CMV pneumonias [1] are the most common. CMV retinitis [2],[3] and encephalitis have been reported in patients of HD and NHL. Only few case reports have documented gastrointestinal CMV infections in lymphoma patients. [4],[5] CMV entrocolitis causing fatal gastrointestinal haemorrhage, intestinal perforation, CMV gastritis and CMV infection of jejunum has been reported. CMV oesophagitis in patients of lymphoma is rarely reported in literature. Apart from fungal and herpes simplex infections, as the common differential diagnosis for oesophagitis in patients of lymphoma, CMV should also be considered an important etiologic agent. Early diagnosis and prompt treatment of CMV oesophagitis with gancyclovir can avert significant morbidity and avoid unacceptable treatment delays. References
Copyright 2008 - Indian Journal of Medical Microbiology The following images related to this document are available:Photo images[mb08018f1.jpg] |
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