Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Simultaneous Herpes Simplex and Candida Esophagitis in Renal Transplant Patients

신장이식 환자에서 동시에 발현한 헤르페스 식도염과 칸디다 식도염 1예

  • Oh, Hyun-Jung (Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine) ;
  • Kim, Seong-Eun (Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine) ;
  • Choi, Ju-Young (Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine) ;
  • Roh, Sun-Hee (Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine) ;
  • Jung, Hye-Kyung (Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine) ;
  • Kim, Tae-Hun (Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine) ;
  • Shim, Ki-Nam (Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine) ;
  • Jung, Sung-Ae (Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine)
  • 오현정 (이화여자대학교 의학전문대학원 내과학교실, 의과학연구소) ;
  • 김성은 (이화여자대학교 의학전문대학원 내과학교실, 의과학연구소) ;
  • 최주영 (이화여자대학교 의학전문대학원 내과학교실, 의과학연구소) ;
  • 노선희 (이화여자대학교 의학전문대학원 내과학교실, 의과학연구소) ;
  • 정혜경 (이화여자대학교 의학전문대학원 내과학교실, 의과학연구소) ;
  • 김태헌 (이화여자대학교 의학전문대학원 내과학교실, 의과학연구소) ;
  • 심기남 (이화여자대학교 의학전문대학원 내과학교실, 의과학연구소) ;
  • 정성애 (이화여자대학교 의학전문대학원 내과학교실, 의과학연구소)
  • Received : 2010.07.30
  • Accepted : 2010.10.17
  • Published : 2010.11.30
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Abstract

Infectious esophagitis usually occurs in immunocompromised patients with AIDS, malignancy and those receiving immunosuppresive therapy. Common pathogens causing esophagitis include Candida, Herpes simplex virus and Cytomegalovirus. However simultaneous esophageal infection with both Candida and Herpes simplex virus has rarely been reported. The endoscopic findings of Herpes simplex esophagitis combined with Candida infection does not show typical findings due to diffuse whitish or yellowish plaques; hence, accurate diagnosis can be delayed. We observed concomitant infection of Herpes simplex virus and Candida causing esophagitis in a 45-year-old renal transplant patient who had been receiving immunosuppressive therapy. The patient showed marked reductions in clinical symptoms and in endoscopic findings after anti-fungal and acyclovir therapy.

감염성 식도염은 후천성 면역 결핍증 환자, 장기간 스테로이드, 면역억제제를 사용하는 장기이식 환자, 항암화학치료나 방사선조사를 받는 악성종양 환자들과 같이 면역 기능이 저하되어 있는 환자에게서 대부분 발생하며, 헤르페스 바이러스 식도염과 칸디다 식도염의 동시감염은 드물게 보고되고 있다. 진단은 내시경을 통한 소견과 조직검사로 할 수 있는데, 헤르페스 바이러스 감염이 심한 칸디다 감염과 중복된 경우 미만성의 흰색 또는 황색 삼출물로 덮힌 판으로 인하여 진단이 되지 않거나 지연될 가능성이 있다. 본 저자들은 신장이식 후 면역억제제를 복용하고 있던 당뇨환자가 혈당 조절이 잘 되지 않던 중 칸디다 및 헤르페스 바이러스 식도염이 동시에 발병하였고 항진균제와 항바이러스제 투여 후 증상과 내시경 소견의 호전을 보인 증례를 보고한다.

Keywords

References

  1. Kato S, Yamamoto R, Yoshimitsu S, et al. Herpes simplex esophagitis in the immunocompetent host. Dis Esophagus 2005;18:340-344. https://doi.org/10.1111/j.1442-2050.2005.00510.x
  2. Seo SH, Lee SS, Park SB, et al. Herpes simplex esophagitis following cadaveric renal transplantation. J Korean Transplant 1999;13:177-181.
  3. Rahhal RM, Ramkumar DP, Pashankar DS. Simultaneous Herpetic and Candidal esophagitis in an immunocompetent teenager. J Pediatr Gastroenterol Nutr 2005;40:371-373. https://doi.org/10.1097/01.MPG.0000155371.92582.D7
  4. Geraci G, Pisello F, Modica G, Li Volsi F, Cajozzo M, Sciume C. Herpes simplex esophagitis in immunocompetent host: a case report. Diagn Ther Endosc 2009;2009:717183. 2009 Sep 9. [Epub ahead of print]
  5. Ponticelli C, Passerini P. Gastrointestinal complication in renal transplant recipients. Transpl Int 2005;18:643-650. https://doi.org/10.1111/j.1432-2277.2005.00134.x
  6. Hyun WJ, Kim SH, Lee SH, et al. A case of Herpes simplex virus esophagitis with Candidal esophagitis in the immunocompetent patient. Korean J Med 2004;67:302-306.
  7. Kurahara K, Aoyagi K, Nakamura S, et al. Treatment of Herpes simplex esophagitis in an immunocompetent patient with intravenous acyclovir: a case report and review of the literature. Am J Gastroenterol 1998;93:2239-2240.
  8. Jung JA, Shin EW, Choi KD, Ko JS, Seo JW, Seo JK. A case of Herpes simplex virus esophagitis in a renal transplant child. Korean J Gastrointest Endosc 2002;24:143-146.
  9. Gelman R, Khankin E, Ben-Itzhak A, Finkelshtein R, Nakhoul F. Herpes simplex viral infection presenting as fever of unknown origin and esophagitis in a renal transplant patient. Isr Med Assoc J 2002;4(suppl 11):970S-971S.
  10. Kim GA, Jeong S, Cho HG, et al. Candida esophagitis: a retrospective study, with emphasis on endoscopic findings. Korean J Gastrointest Endosc 1998;18:145-151.
  11. Kim SM, Yoon JM, Kim BS, et al. Herpes simplex esophagitis presenting as melena: a case report. Korean J Gastrointest Endosc 2001;21:32-35.
  12. Kim MJ, Cho KW, Lee S, et al. Herpetic esophagitis in a renal transplant patient. Korean J Gastrointest Endosc 1990;10:301-304.
  13. Lee JH, Lee OJ, Min HJ, et al. A case of Candida glabrata esophagitis. Korean J Gastrointest Endosc 2003;27:211-215.
  14. Baehr PH, McDonald GB. Esophageal infections: risk factors, presentation, diagnosis, and treatment. Gastroenterology 1994;106:509-532. https://doi.org/10.1016/0016-5085(94)90613-0
  15. Agha FP, Lee HH, Nostrant TT. Herpetic esophagitis: a diagnostic challenge in immunocompromised patients. Am J Gastroenterol 1986;81:246-253.