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

Differential Diagnosis

Esophagitis Types

  • Inflammatory
    • GERD
    • Pill esophagitis (NSAIDs, antibiotics)
    • Allergy (esoninophillic)
  • Infectious Mainly seen in pts 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

CMV Diseases

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

Antivirals

  • Ganciclovir 5mg/kg IV q12hrs daily x 21 days (or until symptom resolution)
  • Foscarnet 90mg/kg IV q12 hrs daily x 21 days (or until symptom resolution)

See Also

External Links

References