Esophageal Stricture -Unusual Presentation of CMV

Case Report

J Gastroenterol Liver Dis. 2023; 8(1): 1019.

Esophageal Stricture -Unusual Presentation of CMV

Dhruv Shah*; Sushil Narang; Kaushal Vyas; Animesh Gupta; Vishal Berriwala

Department of Gastroenterology, SVP Hospital, India

*Corresponding author: Dhruv Shah Department of Gastroenterology, SVP Hospital, Ahmedabad, Gujarat, India. Email: dds240791@gmail.com

Received: April 27, 2023 Accepted: May 24, 2023 Published: May 31, 2023

Abstract

Esophageal stricture due to Cytomegalovirus (CMV) infection is an uncommon pathology, with most reported cases occurring in patients infected with human immunodeficiency virus. We report a case who presented with Odynophagia followed Dysphagia to solids gradually progressive from last 3 weeks with Total Dysphagia to solids and liquids on presentation. Endoscopic examination revealed a long esophageal stricture with a necrotic lesion but no typical CMV esophageal ulcers, with foreign body impaction in form of beans. Histology was positive for CMV. Dysphagia resolved after treatment with ganciclovir and serial esophageal dilations. We are presenting the first case of esophageal stricture due to CMV esophagitis in a young adult with chronic alcoholism and are reviewing current literature.

Introduction

Cytomegalovirus (CMV) ulcerative esophagitis is well described in immunocompromised patients, but esophageal stricture is an exceedingly rare complication [1,2]. Most of the previous case reports of CMV esophagitis complicated with esophageal stricture have been described in patients with acquired immunodeficiency syndrome [1–5]. There is only 1 other reported case in a non-HIV-infected patient but that patient had undergone liver transplant and was on immunosuppressants [6]. This is the first report of esophageal stricture due to CMV in Young adult with Nil Co morbidities.

Case Report

A 30 year-old man presented with Odynophagia followed by Dysphagia to solids gradually progressive from the last 3 weeks with Total Dysphagia to solids and liquids on presentation Patient has chronic alcoholic from last 3 years. Daily alcohol intake in form of country liquor (4-5 Potli daily). His vital signs were blood pressure 114/80mmHg, heart rate 106bpm, temperature 37°C, and SpO2 95% in room air. Physical examination was unremarkable. Serum Hbsag, HCV and HIV testing was negative.

Esophagogastroduodenoscopy showed a severe distal esophageal stricture with near-complete luminal obstruction suggestive of malignancy (Figure 1) with foreign body impaction in form of beans. The stricture could not be traversed with a 6.5-mm pediatric gastroscope but allowed passage of biopsy forceps. There was also foreign body impaction just above stricture. Biopsies from the stricture site and the rest of the esophagus were taken.

Endoscopy Image-

Citation:Shah D, Narang S, Vyas K, Gupta A, Berriwala V. Esophageal Stricture -Unusual Presentation of CMV. J Gastroenterol Liver Dis. 2023; 8(1): 1019.