P0576 - Gastrointestinal Bleeding Due to CMV Esophagitis in an Immunocompetent Patient

Mohammad Alqaisieh, MD¹, Ahmed A. Abdulelah, MD², Anumeet S. Tuli, MD, MBBS¹, Brandee Albert, DO^1
1Hamilton Medical Center, Dalton, GA; ²University of Edinburgh, Edinburgh, Scotland, United Kingdom

Introduction: Cytomegalovirus (CMV) esophagitis usually manifests in immunocompromised individuals such as transplant recipients, HIV-infected patients, malignancies, and dialysis patients. Herein, we discuss a rare case of CMV esophagitis in an immunocompetent patient.

Case Description/Methods: A 68-year-old male patient with a past medical history notable for remote polio infection presented to the hospital with melena 3 days before presentation, his symptoms were associated with generalized weakness and dysphagia mainly to solids. The patient denied any hematochezia, coffee ground emesis, or hematemesis. The patient was not taking any blood thinners, antiplatelet agents, or NSAIDS but admitted to occasional alcohol use. Upon evaluation, the patient was vitally stable, had dry mucous membranes but with a regular rate and rhythm pulse, and his abdomen was flat, and non-distended, the patient was noted to have bilateral lower limb muscle atrophy with foot drop. His blood work was significant for Hb/Hct of 8.2 g/dl /25.9%, Albumin 3.1, AST 38 IU/l /, ALT 30 IU/l. Iron studies are significant for Iron deficiency anemia with a transferrin saturation of 8%. The patient was admitted to the hospital under the GI bleed pathway for which he was started on Pantoprazole 40 mg IV BID. The patient kept having melena for the night, his hemoglobin reached a nadir of 7.2 g/dl. The patient was transfused with one unit of PRBCs for the ongoing GI bleed and had an upper endoscopy done which was significant for mild reflux esophagitis, diffuse gastritis, and a normal duodenum. Pathology results from the lower esophagus were positive for severe erosive/ulcerative esophagitis with abundant markedly inflamed granulation tissue. Surprisingly CMV staining was positive. Serum CMV DNA PCR was positive 1468 IU/ml. IgG was elevated but IgM was low. The patient was started on Valganciclovir 900 mg PO BID for 14 days in addition to pantoprazole 40 mg every day. He finished his treatment after which he significantly felt improvement in his dysphagia, generalized weakness, and his melena resolved. Hb check 2 months later showed an improvement of his Hb to 10.7g/dl. The Patient refused to repeat EGD to assess for resolution.

Discussion: CMV esophagitis is diagnosed with a triad of GI symptoms, erosions or ulcers, biopsy showing viral inclusions, and tissue destruction for which our patient fulfilled all the criteria. Though rarely seen in immune-competent patients, treatment is warranted in this population as well.



Disclosures:


Mohammad Alqaisieh, MD¹, Ahmed A. Abdulelah, MD², Anumeet S. Tuli, MD, MBBS¹, Brandee Albert, DO¹. P0576 - Gastrointestinal Bleeding Due to CMV Esophagitis in an Immunocompetent Patient, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.