Diferencia entre revisiones de «CMV esophagitis»
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== | ==Background== <!--T:1--> | ||
==Differential Diagnosis== | <!--T:2--> | ||
*[[Special:MyLanguage/Cytomegalovirus|Cytomegalovirus]] (CMV) gastrointestinal disease is an uncommon but serious complication of [[Special:MyLanguage/AIDS|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== <!--T:3--> | |||
<!--T:4--> | |||
*[[Special:MyLanguage/Odynophagia|Odynophagia]] | |||
*[[Special:MyLanguage/Dysphagia|Dysphagia]] | |||
*[[Special:MyLanguage/Fever|Fever]] | |||
*[[Special:MyLanguage/Nausea|Nausea]] | |||
*[[Special:MyLanguage/chest pain|Substernal]] burning pain | |||
==Differential Diagnosis== <!--T:5--> | |||
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{{Esophagitis types}} | {{Esophagitis types}} | ||
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{{CMV types}} | {{CMV types}} | ||
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==Evaluation== <!--T:6--> | |||
==Management== <!--T:7--> | |||
<!--T:8--> | |||
**[[Special:MyLanguage/Ganciclovir|Ganciclovir]]: 5mg/kg/dose IV q12h | |||
**[[Special:MyLanguage/Foscarnet|Foscarnet]]: 60mg/kg/dose q8h or 90mg/kg/dose q12h | |||
**[[Special:MyLanguage/Valganciclovir|Valganciclovir]]: 900mg PO twice daily | |||
***May be used for induction therapy, in place of intravenous [[Special:MyLanguage/ganciclovir|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== <!--T:9--> | |||
==See Also== <!--T:10--> | |||
<!--T:11--> | |||
*[[Special:MyLanguage/Cytomegalovirus (CMV) infection|Cytomegalovirus (CMV) infection]] | |||
== | ==External Links== <!--T:12--> | ||
== | ==References== <!--T:13--> | ||
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<references/> | <references/> | ||
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[[Category:ID]] [[Category:GI]] | [[Category:ID]] [[Category:GI]] | ||
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Revisión actual - 12:26 7 ene 2026
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
- Odynophagia
- Dysphagia
- Fever
- Nausea
- Substernal burning pain
Differential Diagnosis
Esophagitis Types
- Inflammatory
- GERD
- Allergic (eosinophilic)
- Infectious Mainly seen in patients w/ immunosuppression (HIV/AIDS, cancer, steroids)
- Esophageal candidiasis: often an AIDS defining lesion
- HSV
- CMV esophagitis
- aphthous ulceration
- Medication-induced (i.e. "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
See Also