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 Features
- Odynophagia
- Dysphagia
- Fever
- Nausea
- Substernal burning pain
Differential Diagnosis
Esophagitis Types
- Inflammatory
- GERD
- Allergy (eosinophilic)
- Infectious Mainly seen in patients w/ immunosuppression (HIV/AIDS, cancer, steroids)
- Esophageal candidiasis: often an AIDS defining lesion
- HSV, CMV esophagitis, aphthous ulceration
- Pill esophagitis, common culprits:
- Doxycycline
- Tetracycline
- Clindamycin
- NSAIDs
- ASA
- Bisphosphonates
- Ferrous sulfate
- Potassium chloride
- Ascorbic acid
Evaluation
Management
- Ganciclovir: 5mg/kg/dose IV q12h
- Foscarnet: 60mg/kg/dose q8h or 90mg/kg/dose q12h
- Valganciclovir: 900mg 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
- 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
See Also
External Links
References
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