Open AccessRare cause of odynophagia: Giant esophageal ulcer
Author(s) -
Massimiliano Veroux,
Giuseppe Aprile,
Francesca F Amore,
Daniela Corona,
Alessia Giaquinta,
Pierfrancesco Veroux
Publication year - 2016
Publication title -
world journal of gastroenterology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.427
H-Index - 155
eISSN - 2219-2840
pISSN - 1007-9327
DOI - 10.3748/wjg.v22.i14.3875
Subject(s) - odynophagia , medicine , esophageal ulcer , immunosuppression , surgery , kidney transplantation , cytomegalovirus , complication , esophagus , transplantation , gastroenterology , viral disease , human immunodeficiency virus (hiv) , immunology , herpesviridae
Gastrointestinal complications are a frequent cause of morbidity after transplantation and may affect up to 40% of kidney transplant recipients. Here we report a rare case of idiopathic giant esophageal ulcer in a kidney transplant recipient. A 37-year-old female presented with a one-week history of odynophagia and weight loss. Upon admission, the patient presented cold sores, and a quantitative cytomegalovirus polymerase chain reaction was positive (10(5) copies/mL). An upper endoscopy demonstrated the presence of a giant ulcer. Serological test and tissue biopsies were unable to demonstrate an infectious origin of the ulcer. Immunosuppression was reduced and everolimus was introduced. An empirical i.v. therapy with acyclovir was started, resulting in a dramatic improvement in symptoms and complete healing of the ulcer. Only two cases of idiopathic giant esophageal ulcer in kidney transplant recipients have been reported in the literature; in both cases, steroid therapy was successful without recurrence of symptoms or endoscopic findings. However, this report suggests that correction of immune imbalance is mandatory to treat such a rare complication.