Catastrophic gastrointestinal complication of systemic immunosuppression.
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We present a case of acute upper gastrointestinal haemorrhage in a patient with systemic vasculitis immunosuppressed on cyclophosphamide and prednisolone. The patient presented with a diffuse haemorrhagic oesophagitis and a non-specific duodenitis. Biopsies taken from the oesophagus and duodenum demonstrated infection with herpes simplex virus (HSV) and cytomegalovirus (CMV) respectively. Viral infection of the upper gastrointestinal tract is a recognised complication of immunosuppression and HSV is one of the most common pathogens. CMV on the other hand most commonly causes a colitis or less commonly oesophagitis. CMV enteritis is rare as is the synchronous infection with two viral agents in an immunocompromised patient having being described in a few case series only. Viral infection of the gastrointestinal tract in immunocompromised patients should be treated with systemic anti-viral medication and consideration to withdrawal of the immunosuppressive therapy if possible and appropriate. The authors highlight the need for a high suspicion of viral infection in immunosuppressed patients presenting with upper gastrointestinal bleeding.
[1] E. Oldfield,et al. Gastrointestinal cytomegalovirus disease in the immunocompromised patient , 2008, Current gastroenterology reports.
[2] A. Cerar,et al. Synchronous herpes simplex virus and cytomegalovirus esophagitis. , 2000, Zeitschrift fur Gastroenterologie.
[3] F. Rozenberg,et al. Herpes esophagitis: a comprehensive review. , 1997, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.