The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지

A case of esophagitis caused by co-infection of cytomegalovirus and candida

칸디다와 거대세포바이러스의 동시 감염에 의한 식도염 1예

  • Hwang, Hee-Young (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Kim, Shin-Woo (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Chang, Hyun-Ha (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Kim, Hye-In (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Park, Ga-Young (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Kwon, Eu-Gene (Department of Internal Medicine, Kyungpook National University School of Medicine) ;
  • Lee, Jong-Myung (Department of Internal Medicine, Kyungpook National University School of Medicine)
  • 황희영 (경북대학교 의학전문대학원 내과학교실) ;
  • 김신우 (경북대학교 의학전문대학원 내과학교실) ;
  • 장현하 (경북대학교 의학전문대학원 내과학교실) ;
  • 김혜인 (경북대학교 의학전문대학원 내과학교실) ;
  • 박가영 (경북대학교 의학전문대학원 내과학교실) ;
  • 권유진 (경북대학교 의학전문대학원 내과학교실) ;
  • 이종명 (경북대학교 의학전문대학원 내과학교실)
  • Received : 2009.08.04
  • Accepted : 2009.10.05
  • Published : 2010.07.01
⟨ Previous Next ⟩

Abstract

A 72-year-old man with end-stage renal disease who was taking oral steroids and immunosuppressive agents to control rheumatoid arthritis was admitted with complaints of anorexia and general weakness. Based on endoscopic findings and a histologic examination, the patient was diagnosed with infective esophagitis caused by Candida spp. and cytomegalovirus co-infection. Cytomegalovirus and Candida spp. are common causes of opportunistic infections; however, cytomegalovirus and Candida spp. co-infection is very rare. The patient was treated with ganciclovir and fluconazole. Endoscopic examination after 3 weeks showed improvement of the esophagitis. When endoscopy examination shows typical white spots that are indicative of Candida esophagitis, histologic and microbiologic studies should be encouraged for cytomegalovirus and Candida co-infection, especially in immunocompromised patients.

칸디다와 거대세포바이러스 감염은 세포 매개성 면역이 저하된 환자에 있어서 기회감염의 원인으로 알려져 있다. 저자 등은 제2형 당뇨병 및 말기 신부전, 스테로이드, 면역억제제를 복용하고 있는 환자에서 상부 내시경검사 및 조직검사로 진단된 칸디다와 거대세포바이러스의 동시 감염에 의한 식도염 1예를 진단, 치료하게 되어 보고하는 바이다.

Keywords

References

  1. Chetty R, Roskell DE. Cytomegalovirus infection in the gastrointestinal tract. J Clin Pathol 47:968-972, 1994 https://doi.org/10.1136/jcp.47.11.968
  2. Hingmire SS, Biswas G, Bakshi A, Desai S, Dighe S, Nair R, Gupta S, Parikh PM. Cytomegalovirus oesophagitis in a patient with non-Hodgkin's lymphoma. Indian J Med Microbiol 26:79-80, 2008 https://doi.org/10.4103/0255-0857.38866
  3. Francis ND, Boylston AW, Roberts AH, Parkin JM, Pinching AJ. Cytomegalovirus infection in gastrointestinal tracts of patients infected with HIV-1 or AIDS. J Clin Pathol 42:1055-1064, 1989 https://doi.org/10.1136/jcp.42.10.1055
  4. Buckner FS, Pomeroy C. Cytomegalovirus disease of the gastrointestinal tract in patients without AIDS. Clin Infect Dis 17:644-656, 1993 https://doi.org/10.1093/clinids/17.4.644
  5. Kliemann DA, Pasqualotto AC, Falavigna M, Giaretta T, Severo LC. Candida esophagitis: species distribution and risk factors for infection. Rev Inst Med Trop Sao Paulo 50:261-263, 2008 https://doi.org/10.1590/S0036-46652008000500002
  6. Laine L, Bonacini M. Esophageal disease in human immunodeficiency virus infection. Arch Intern Med 154:1577-1582, 1994 https://doi.org/10.1001/archinte.154.14.1577
  7. Wilcox CM, Karowe MW. Esophageal infections: etiology, diagnosis, and management. Gastroenterologist 2:188-206, 1994
  8. Mathieson R, Dutta SK. Candida esophagitis. Dig Dis Sci 28:365-370, 1983 https://doi.org/10.1007/BF01324956
  9. Phaosawasdi K, Rice P, Lee B. Primary and secondary Candida esophagitis. IMJ Ill Med J 169:361-365, 1986
  10. Vermeersch B, Rysselaere M, Dekeyser K, Rasquin K, De Vos M, Elewaut A, Barbier F. Fungal colonization of the esophagus. Am J Gastroenterol 84:1079-1083, 1989
  11. Weerasuriya N, Snape J. A study of Candida esophagitis in elderly patients attending a district general hospital in the UK. Dis Esophagus 19:189-192, 2006 https://doi.org/10.1111/j.1442-2050.2006.00563.x
  12. Hyun WJ, Kim SH, Lee SH, Yoon SJ, Jung SH, Song KR, Cho SY. A case of herpes simplex virus esophagitis with candidal esophagitis in the immunocopetent patient. Korea J Med 67:302-306, 2004
  13. McDonald GB SH, Sullivan KM, Spencer GD. Intestinal and hepatic complications of human bone marrow transplantation. Part II. Gastroenterology:770-784, 1986
  14. Chen LI, Chang JM, Kuo MC, Hwang SJ, Chen HC. Combined herpes viral and candidal esophagitis in a CAPD patient: case report and review of literature. Am J Med Sci 333:191-193, 2007 https://doi.org/10.1097/MAJ.0b013e318031b1f2
  15. Bonacini M, Young T, Laine L. The cause of esophageal symptoms in human immunodeficiency virus infection: a prospective study of 110 patients. Arch Intern Med 151:1567-1572, 1991 https://doi.org/10.1001/archinte.151.8.1567
  16. Kim HA, Bae KH, Ruy SY. A case of combined herpes simplex virus, cytomegalovirus, and candidal esophagitis in an AIDS patient. Korean J Med 77:255-260, 2009
  17. Mirra SS, Bryan JA, Butz WC, Miles ML. Concomitant herpes-monilial esophagitis: case report with ultrastructural study. Hum Pathol 13:760-763, 1982 https://doi.org/10.1016/S0046-8177(82)80300-6
  18. Mocarski ES Jr. Immunomodulation by cytomegaloviruses: manipulative strategies beyond evasion. Trends Microbiol 10:332-339, 2002 https://doi.org/10.1016/S0966-842X(02)02393-4