CMV esophagitis

Background

• Cytomegalovirus (CMV) gastrointestinal disease is an uncommon but serious complication of AIDS.
• The diagnosis of CMV gastrointestinal disease should be suspected in patients with CD4 cell counts <50 cells/microL who present with symptoms of esophagitis, gastritis, enteritis, or colitis.
• The incidence of CMV gastrointestinal disease has decreased substantially since antiretroviral therapy (ART) became available

Clinical Presentation

• Odynophagia
• Dysphagia
• Fever
• Naseau
• Substernal burning pain

Differential Diagnosis

Esophagitis Types

• Inflammatory
  • GERD
  • Allergic (eosinophilic)
• Infectious Mainly seen in patients w/ immunosuppression (HIV/AIDS, cancer, steroids)
  • Esophageal candidiasis: often an AIDS defining lesion
  • HSV
  • CMV esophagitis
  • aphthous ulceration
• Medication-induced (i.e. "pill") esophagitis, common culprits:
  • Doxycycline
  • Tetracycline
  • Clindamycin
  • NSAIDs
  • ASA
  • Bisphosphonates
  • Ferrous sulfate
  • Potassium chloride
  • Ascorbic acid

CMV Diseases

• CMV esophagitis
• CMV colitis
• CMV pneumonia
• CMV retinitis
• CMV neurologic disease

Management

• Template:Induction therapy:
  • Ganciclovir: 5 mg/kg/dose IV q12h
  • foscarnet: 60 mg/kg/dose q8h or 90 mg/kg/dose q12h
  • Valganciclovir: 900 mg PO twice daily
    • May be used for induction therapy, in place of intravenous ganciclovir, in patients who can tolerate and absorb oral medications
  • The recommended duration of therapy for CMV gastrointestinal disease in patients with AIDS is 3-6 weeks

• Template:Management Therapy:
  • Chronic maintenance therapy is not recommended for CMV gastrointestinal disease unless there is concurrent retinitis or recurrent gastrointestinal disease after induction therapy has been discontinued.

Disposition

Antivirals

• Ganciclovir 5mg/kg IV q12hrs daily x 21 days (or until symptom resolution)
• Foscarnet 90mg/kg IV q12 hrs daily x 21 days (or until symptom resolution)

See Also

• Cytomegalovirus (CMV) infection