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Mahajan N, Sharma A, Nasa M, Lipi L, Sharma R, Arora N, Singh B. CMV Disease of Upper GI Tract in Immunocompetent Host: Two Case Reports and Brief Review of Literature. JOURNAL OF DIGESTIVE ENDOSCOPY 2020. [DOI: 10.1055/s-0040-1716449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractGastrointestinal cytomegalovirus (GI-CMV) infection is well-reported in immunocompromised individuals and those on chemotherapy or other immunosuppressive medications. Rarely, CMV infection of gastrointestinal tract (GIT) occurs in immunocompetent individuals. Colon is the most common site of GI involvement with CMV. However, in immunocompetent individuals, upper GIT involvement is more common. Clinical spectrum of GI-CMV disease is variable and depends on the location and severity of the disease. Prompt diagnosis and treatment aids in reducing morbidity and mortality related to CMV involvement in GI tract. We present two interesting cases of CMV-induced GI ulcers in immunocompetent individuals with brief review of diagnostic and treatment challenges associated with CMV disease in immunocompetent individuals.
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Affiliation(s)
- Nikhil Mahajan
- Department of Gastroenterology, Shrimann Hospital, Jalandhar, Punjab, India
- Department of Gastroenterology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Aproo Sharma
- Department of Pathology, AFCME, New Delhi, India
| | - Mukesh Nasa
- Department of Gastroenterology, Shrimann Hospital, Jalandhar, Punjab, India
| | - Lipika Lipi
- Department of Gastro-Pathology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Rini Sharma
- Department of Pathology, ASCOMS, Jammu, J & K, India
| | - Navleen Arora
- Department of Pathology, Shrimann Hospital, Jalandhar, Punjab, India
| | - Balwinder Singh
- Department of Gastroenterology, Shrimann Hospital, Jalandhar, Punjab, India
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Vaiphei K, Kochhar R, Bhardawaj S, Dutta U, Singh K. High prevalence of human papillomavirus in esophageal squamous cell carcinoma: a study in paired samples. Dis Esophagus 2013; 26:282-7. [PMID: 22676445 DOI: 10.1111/j.1442-2050.2012.01365.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Esophageal squamous cell carcinoma (ESCC) is one of the common cancers with a poor prognosis. Incidences of human papillomavirus (HPV) infection range from 0 to 67% in different parts of the world. It has been frequently associated with high-risk HPV genotypes 16 and 18. The present study analyzes the prevalence of HPV infection in ESCC tumor and adjoining mucosa. Fresh tissue samples were obtained from ESCC tumor (group I) and adjoining mucosa (group II). Aliquots of DNA extracts were used. There were 23 patients with paired samples, 19 (83%) were male. HPV was positive in 20/23 (87%). Mean age of HPV positive in group I was 56.63 ± 6.96 and in group II 54.31 ± 7.13 years (P > 0.05). Majority had more than one viral type. HPV52 was the most common observed in 14 (61%) males and two (9%) females. Other common viruses were HPV55, 39, and 59. Smoking had a significant association with viral positivity. p63 and p16 oncoproteins correlated with degree of tumor differentiation but not with viral status. We documented high prevalence of high-risk HPV in ESCC. Our observations support the concept of persistent infection by an oncogenic HPV in cancer development. Our study highlights importance of documenting viral genotype in a defined geographic area.
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Affiliation(s)
- K Vaiphei
- Departments of Histopathology Gastroenterology, PGIMER, Chandigarh, India.
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Yahyapour Y, Shamsi-Shahrabadi M, Mahmoudi M, Motevallian A, Siadati S, Shefaii S, Shirvani JS, Mollaie HR, Monavari SHR, Keyvani H. High-Risk and Low-Risk Human Papillomavirus in Esophageal Squamous Cell Carcinoma at Mazandaran, Northern Iran. Pathol Oncol Res 2012; 19:385-91. [DOI: 10.1007/s12253-012-9590-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 11/08/2012] [Indexed: 01/22/2023]
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Chandrasekhara V, Zhang L, Floyd BNI, Kochman ML. A rare cause of esophageal strictures: Actinomyces. Gastrointest Endosc 2012; 75:1111-2. [PMID: 21820113 DOI: 10.1016/j.gie.2011.05.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 05/26/2011] [Indexed: 02/08/2023]
Affiliation(s)
- Vinay Chandrasekhara
- Gastroenterology Division, Department of Internal Medicine, University of Pennsylvania Health System, Philadelphia, Philadelphia, USA
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Abstract
Herpes simplex virus is a common cause of ulcerative esophagitis in the immunocompromised or debilitated host. Despite a high prevalence of primary and recurrent Herpes simplex virus infection in the general population, Herpes simplex virus esophagitis (HSVE) appears to be rare in the immunocompetent host. We report three cases of endoscopically-diagnosed HSVE in apparently immunocompetent children; the presentation was characterized by acute onset of fever, odynophagia, and dysphagia. In two cases, the diagnosis was confirmed histologically by identification of herpes viral inclusions and culture of the virus in the presence of inflammation. The third case was considered to have probable HSVE based on the presence of typical cold sore on his lip, typical endoscopic finding, histopathological evidence of inflammation in esophageal biopsies and positive serologic evidence of acute Herpes simplex virus infection. Two cases received an intravenous course of acyclovir and one had self-limited recovery. All three cases had normal immunological workup and excellent health on long-term follow-up.
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Affiliation(s)
- Abdulrahman A. Al-Hussaini
- Department of Pediatrics, Division of Pediatric Gastroenterology, Children's Hospital, Riyadh, Saudi Arabia,Address for correspondence: Dr. Abdulrahman Al-Hussaini, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital, King Fahad Medical City, Riyadh Postal code 11525, Saudi Arabia. E-mail:
| | - Mosa A. Fagih
- Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia
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Katiyar S, Hedau S, Jain N, Kar P, Khuroo MS, Mohanta J, Kumar S, Gopalkrishna V, Kumar N, Das BC. p53 gene mutation and human papillomavirus (HPV) infection in esophageal carcinoma from three different endemic geographic regions of India. Cancer Lett 2005; 218:69-79. [PMID: 15639342 DOI: 10.1016/j.canlet.2004.09.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2004] [Revised: 09/08/2004] [Accepted: 09/08/2004] [Indexed: 12/23/2022]
Abstract
Infection of high-risk human papillomaviruses (HPVs), particularly the HPV types 16 and 18 and mutation or aberrant expression of the p53 tumour suppressor gene, has strongly been implicated in human esophageal carcinoma, which shows a great variation in geographic distribution. Neither the reason(s) for such a variation nor the etiopathogenesis of the disease is clearly understood. The present study has been carried out to determine prevalence of high-risk HPV types 16 and 18 and the p53 gene mutation in patients from three distinctly different endemic geographic regions of India, viz. Kashmir, Dibrugarh, and New Delhi where esophageal cancer is most prevalent. The people from each of these regions differ considerably in their food, drinking, smoking and chewing habits (tobacco and betel nut) and ethnic background. While PCR was employed to detect high-risk HPV types 16 and 18 DNA sequences, PCR-SSCP and direct nucleotide sequencing was used for analysis of p53 mutation. Out of a total of 101 biopsy specimens of carcinoma esophagus analysed, the frequency of HPV was found to be the highest 14/32 (44%) in Dibrugarh followed by 33% (11/33) in Kashmir, but, interestingly, no high-risk HPV could be detected in New Delhi patients who showed the highest frequency (30.6%) of p53 mutation as against only 12.5% in Dibrugarh and 6.1% in Kashmir. The difference in the frequency of p53 mutation between the three regions was statistically highly significant (0.018). Out of a total of 21 nucleotide alterations observed, 12 missense, five frameshift and four were silent changes. The p53 exon 7 appears to be the 'hot-spot' for esophageal cancer as it alone was responsible for more than 76% (13/17) of mutations and more than 95% (20/21) of the patients with p53 mutation were smokers. The results demonstrate differential distribution of HPV infection and p53 mutation in esophageal cancer from different geographic regions of India and this could be due to variation in diet, drinking, and tobacco habit, including ethnic, socio-cultural and genetic variation.
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Affiliation(s)
- Sanjay Katiyar
- Division of Molecular Oncology, Institute of Cytology and Preventive Oncology (ICMR), Maulana Azad Medical College Campus, Bahadur Shah Zafar Marg, New Delhi 110 002, India
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Contreras MA, Salas C, Andreu JL, Mulero J. Cytomegalovirus Esophagitis as a Treatable Complication of Systemic Sclerosis. J Clin Rheumatol 2001; 7:384-7. [PMID: 17039180 DOI: 10.1097/00124743-200112000-00007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We report the case of a 51-year-old woman with a connective tissue disease of 8 years duration. She had been taking corticosteroids at a dose of 1 mg/kg/day and azathioprine at a dose of 3 mg/kg/day for 1 month. Given the clinical suspicion of systemic sclerosis (limited form of scleroderma), she was studied according to a protocol including endoscopy to assess the degree to which the underlying disease had affected the gastrointestinal tract. Endoscopy revealed a asymptomatic severe esophagitis and a subsequent biopsy disclosed the presence of cytomegalovirus. Cytomegalovirus pneumonia was also detected. Both processes were successfully managed with intravenous ganciclovir (5 mg/kg/12 hr) for 21 days. This report is a case of cytomegalovirus involving the esophagus in association with systemic sclerosis in a patient immunosuppressed because of drugs that she had been taking. This complication can be asymptomatic and is amenable to treatment.
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Affiliation(s)
- M A Contreras
- Department of Rheumatology, Clínica Puerta de Hierro, Madrid, Spain
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Lacy BE, Toor A, Bensen SP, Rothstein RI, Maheshwari Y. Acute esophageal necrosis: report of two cases and a review of the literature. Gastrointest Endosc 1999; 49:527-32. [PMID: 10202074 DOI: 10.1016/s0016-5107(99)70058-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- B E Lacy
- Section of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, and the Veteran's Administration Hospital, White River Junction, Vermont, USA
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Richert SM, Orchard JL. Bacterial esophagitis associated with CD4+ T-lymphocytopenia without HIV infection. Possible role of corticosteroid treatment. Dig Dis Sci 1995; 40:183-5. [PMID: 7821107 DOI: 10.1007/bf02063963] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Although infectious esophagitis is usually due to infection with Candida, herpes virus, or cytomegalovirus, bacterial esophagitis is occasionally observed. Recently, patients have been reported with CD4+ T-lymphocytopenia without HIV infection. Bacterial esophagitis per se has not been reported in these patients. We report the case of an 80-year-old patient admitted with a COPD exacerbation after being on chronic steroids. The patient developed esophageal symptoms and was found to have bacterial esophagitis by biopsy. Her CD4+ counts were found to be low, but she denied HIV risk factors and HIV testing was negative. Her CD4+ counts rose into the normal range as her steroids were tapered, and her esophagitis improved on antibiotics. This case is reported to alert physicians to the possible association of bacterial esophagitis with CD4+ T-lymphocytopenia without HIV infection and to discuss the possible etiological role of corticosteroid treatment.
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Affiliation(s)
- S M Richert
- Department of Medicine and Gastroenterology, Mercy Hospital, Pittsburgh, Pennsylvania 15219-5166
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Venkataramani A, Schlueter AJ, Spech TJ, Greenberg E. Cytomegalovirus esophagitis in an immunocompetent host. Gastrointest Endosc 1994; 40:392-3. [PMID: 8056263 DOI: 10.1016/s0016-5107(94)70094-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Ponz de Leon M. Genetic factors in precancerous lesions and cancer of the esophagus. Recent Results Cancer Res 1994; 136:162-178. [PMID: 7863094 DOI: 10.1007/978-3-642-85076-9_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- M Ponz de Leon
- Università degli Studi di Modena, Istituto di Patologia Medica, Italy
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Affiliation(s)
- I Thomas
- East Orange Veterans Administration Medical Center, New Jersey
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Abstract
Extensive epidemiological and experimental studies have suggested that some chemical agents, nutritional deficiencies, and physical factors are associated with the development of esophageal cancer (EC). Recent evidence also suggests an etiologic role of certain microorganisms in esophageal carcinogenesis either by producing carcinogens or promotors or by acting directly on the host cells. The mutagenic and carcinogenic effects of several fungi and bacteria isolated from the grains and foodstuffs in high-risk areas have been shown by in vitro and in vivo studies. Certain viruses, e.g., human papillomavirus, herpes simplex virus, cytomegalovirus, and Epstein-Barr virus, have been implicated in the pathogenesis of a variety of human cancers, and all of them are known to produce tumors in animals and cell transformation in vitro. These viruses also have been shown to infect the esophageal epithelium. Therefore, although many of the key issues of their mechanisms of action are unclear as yet, they should be considered potential etiologic agents of EC. The present review summarizes the data available on the etiology of EC, emphasizing the current evidence implicating an etiologic role of microorganisms in the pathogenesis of this malignancy.
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Affiliation(s)
- F Chang
- Department of Pathology, University of Kuopio, Finland
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Pauwels A, Lecomte I, Eliaszewicz M, Meyohas M. Oesophagites infectieuses au cours de l'infection à VIH. Rev Med Interne 1990. [DOI: 10.1016/s0248-8663(10)80006-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Esophagitis of varying degrees and significance is caused by reflux, infections, radiation, and ingestion of chemical agents. A case of necrotizing esophagitis, seen as a black esophagus on endoscopy in a postoperative patient and resulting in long tubular stricture which ultimately required esophagectomy, is reported. Although the course of necrotizing esophagitis may parallel that associated with ischemia, severe caustic injury, or overwhelming infection, its etiology is uncertain. Diminished mucosal defenses, microbial implantation by a nasogastric tube placed perioperatively or sepsis, and transient ischemia with oxyradical formation and resultant reperfusion injury are hypothesized as important causative factors in the pathogenesis of acute necrotizing esophagitis.
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Affiliation(s)
- S P Goldenberg
- Department of Medicine, Griffin Hospital, Derby, Connecticut
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