[Esophagitis during immunosuppression]

Area of Science:

• Gastroenterology and Infectious Diseases
• Immunology and Rheumatology

Background:

• Cytomegalovirus (CMV) esophagitis is predominantly documented in individuals with acquired immunodeficiency syndrome (AIDS).
• Characteristic endoscopic findings include distal and hemorrhagic ulcerations of the esophagus.

Observation:

• CMV esophagitis can manifest in non-human immunodeficiency virus (HIV)-infected patients as a consequence of immunosuppressive treatment.
• A presented case involved excessive long-term prednisolone dosage leading to CMV esophagitis.
• Published cases of CMV esophagitis in rheumatic diseases consistently involved high-dose glucocorticoid therapy.

Findings:

• Excessive and prolonged glucocorticoid use, such as high-dose prednisolone, is a risk factor for CMV esophagitis.
• Rheumatic disease patients on glucocorticoids are particularly susceptible to this opportunistic infection.

Implications:

• Regular rheumatological screening and judicious adjustment of immunosuppressive therapy are crucial.
• Maintaining disease control with minimized glucocorticoid dosage is essential for preventing CMV esophagitis.
• This highlights the importance of balancing immunosuppression for rheumatic conditions with the risk of opportunistic infections.