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- Title
Infectious esophagitis superimposed on eosinophilic esophagitis: A report of two cases.
- Authors
Qi Yang; Shih, Francis; Dupré, Marc P.
- Abstract
Background: Eosinophilic esophagitis (EoE) is a wellcharacterized form of chronic esophagitis which often presents with typical clinical, endoscopic and pathologic findings. Treatment consists of inhaled corticosteroids and complications of EoE include esophageal ulceration and strictures. Infectious esophagitis co-existing with or complicating EoE is uncommon. Case reports: We describe two cases of eosinophilic esophagitis coexisting with infectious esophagitis. In the first case, a 24-year-old male with dysphagia underwent upper endoscopy with biopsies of endoscopically classic EoE. In addition to histologic features of eosinophilic esophagitis, viral cytopathic changes of HSV were identified in esophageal mucosa. Immunohistochemistry confirmed the presence of HSV. In the second case, a 43-year-old female patient with a 5-year history of EoE treated with fluticasone underwent biopsies for recurrent dysphagia and candidiasis was suspected endoscopically. In addition to changes of EoE, candidiasis was confirmed histologically. Conclusions: Infectious esophagitis co-existing with or complicating the course of treated EoE has been infrequently reported in the literature. Of the previously published examples, HSV esophagitis is the most frequently cited cause of infectious esophagitis associated with EoE and candidiasis is less common. Although iatrogenic immunosuppression from inhaled corticosteroid therapy and mucosal ulcers may predispose to opportunistic infections from these pathogens, some authors have proposed that HSV may act as a trigger for subsequent development of EoE in pediatric patients. Although a rare occurrence, pathologists should be aware of the possible co-existence of EoE and infectious esophagitis as its' recognition in daily practice is important for patient management.
- Publication
Canadian Journal of Pathology, 2016, Vol 8, p36
- ISSN
1918-915X
- Publication type
Article