acyclovir and Esophageal-Diseases

CMV disease is a major problem in AIDS, though with a different profile from that seen in other immunosuppressed patients. The novel treatments, ganciclovir and phosphonoformate, have a major role in the management of such infections, but maintenance therapy is often required. Optimal maintenance regimens have yet to be established, especially where zidovudine is also being used.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Addison Disease; Antiviral Agents; Colitis; Cytomegalovirus Infections; Encephalitis; Esophageal Diseases; Foscarnet; Ganciclovir; Humans; Phosphonoacetic Acid; Pneumonia, Viral; Retinitis

A 77-year-old woman presented with a 2-week history of malaise, prostration, anorexia, abdominal pain, vomiting and diarrhoea. She had been taking systemic corticosteroids for the past year. During hospitalisation, renal insufficiency, ionic changes and liver function abnormalities were detected and corrected. However, the patient developed total dysphagia. UGE revealed multiple shallow ulcers below the cricopharyngeal level and in the distal oesophagus, with normal-appearing intervening mucosa. Histological examination allowed the diagnosis of herpes simplex virus esophagitis. Treatment with intravenous acyclovir was instituted for 14 days. In the elderly, herpetic esophagitis may present with non-specific complains, such as prostration or anorexia. In the reported case, dysphagia was only detected as a late symptom, addressing the importance of maintaining a high degree of suspicion for the diagnosis of herpes simplex virus esophagitis.

Topics: Acyclovir; Aged; Esophageal Diseases; Esophagitis; Female; Herpes Simplex; Humans; Simplexvirus

Topics: Acyclovir; Antiviral Agents; Esophageal Diseases; Fetal Blood; Herpes Simplex; Humans; Male; Middle Aged; Ulcer

Topics: Acyclovir; Antiviral Agents; Biopsy; Darier Disease; Esophageal Diseases; Esophagoscopy; Etretinate; Humans; Keratolytic Agents; Male; Middle Aged; Valacyclovir; Valine

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; DNA, Viral; Duodenal Ulcer; Esophageal Diseases; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Stomach Ulcer; Ulcer

Topics: Acyclovir; Antiviral Agents; Delayed Diagnosis; Diagnosis, Differential; Diagnostic Errors; Esophageal Diseases; Herpes Simplex; Humans; Male; Middle Aged; Peptic Ulcer; Wound Healing

Immunosuppressive agents (azathioprine, methotrexate) are increasingly being used in the treatment of inflammatory bowel disease. The use of immunosuppressive agents is associated with a greater risk of opportunistic infections, the most frequent of which are those caused by cytomegalovirus and varicella zoster virus. We present four cases of opportunistic infections due to Herpesviruses in patients undergoing immunosuppressive treatment with azathioprine for Crohn's disease. We also review the literature published on this topic. Two patients presented cutaneous varicella complicated by pneumonia and esophagitis respectively, one patient had cutaneous herpes zoster and the other had fatal pneumonia possibly caused by the Herpesvirus. In the first three the clinical course of the infection was favorable after withdrawing immunosuppressant treatment and initiating treatment with aziclovir. In patients Crohn's disease azathioprine treatment increases the risk of opportunistic infection by Herpesvirus. However, in the absence of other factors that increase immunosuppression, these infections usually have a benign course with specific antiviral therapy.

Topics: Acyclovir; Adult; Aged; Antiviral Agents; Azathioprine; Chickenpox; Crohn Disease; Disease Susceptibility; Esophageal Diseases; Fatal Outcome; Female; Ganciclovir; Hepatitis, Viral, Human; Herpes Zoster; Herpesviridae Infections; Humans; Immunosuppressive Agents; Leukopenia; Lymphopenia; Male; Opportunistic Infections; Pneumonia, Viral