Vodovnik A, Cerar A
Institute of Pathology, School of Medicine, Ljubljana, Slovenia.
Z Gastroenterol. 2000 Jun;38(6):491-4. doi: 10.1055/s-2000-14887.
Infective esophagitis is a rare disease, affecting mostly immunocompromised patients. Very few cases of a multiple viral infection have been reported. We present a case of combined cytomegalovirus (CMV) and herpes simplex virus (HSV) esophagitis in an 81-year-old female with extracapillary sclerosing glomerulonephritis treated for five months with steroids and chemotherapy. She died of septic shock. At autopsy, erosive and ulcerative esophagitis was found in the distal half of the esophagus. Slides were stained by HE, and the immunohistochemical avidin-biotin method was used to detect HSV and CMV infection. On histological examination of the esophagus, epithelial giant cells with intranuclear viral inclusions showing HSV immunopositivity were found at the margin of the ulcerations. Giant cells with intranuclear inclusions with CMV immunopositivity were also found in the mesenchymal cells obtained from the ulcer bed. Long-term immunosuppressive therapy provoked an immune deficiency, evidenced by grave leukopenia and depletion of all bone marrow elements. Diagnosis of HSV and CMV esophagitis is important to evaluate the risk of hemorrhage and esophageal perforation in esophagitis.
感染性食管炎是一种罕见疾病，主要影响免疫功能低下的患者。多重病毒感染的病例报道极少。我们报告一例81岁患有毛细血管外硬化性肾小球肾炎的女性患者，合并巨细胞病毒（CMV）和单纯疱疹病毒（HSV）食管炎，该患者接受了五个月的类固醇和化疗治疗。她死于感染性休克。尸检时，在食管远端半部发现糜烂性和溃疡性食管炎。切片用苏木精-伊红（HE）染色，并采用免疫组织化学抗生物素蛋白-生物素方法检测HSV和CMV感染。在食管组织学检查中，在溃疡边缘发现有核内病毒包涵体且HSV免疫阳性的上皮巨细胞。在从溃疡床获取的间充质细胞中也发现有核内包涵体且CMV免疫阳性的巨细胞。长期免疫抑制治疗引发免疫缺陷，表现为严重白细胞减少和所有骨髓成分耗竭。诊断HSV和CMV食管炎对于评估食管炎患者出血和食管穿孔的风险很重要。
