Published online Feb 28, 2015. doi: 10.3748/wjg.v21.i8.2542
Peer-review started: July 5, 2014
First decision: July 21, 2014
Revised: August 4, 2014
Accepted: November 19, 2014
Article in press: November 19, 2014
Published online: February 28, 2015
We present a case of acute upper gastrointestinal haemorrhage in a patient with systemic vasculitis immunosuppressed on cyclophosphamide and prednisolone. The patient presented with a diffuse haemorrhagic oesophagitis and a non-specific duodenitis. Biopsies taken from the oesophagus and duodenum demonstrated infection with herpes simplex virus (HSV) and cytomegalovirus (CMV) respectively. Viral infection of the upper gastrointestinal tract is a recognised complication of immunosuppression and HSV is one of the most common pathogens. CMV on the other hand most commonly causes a colitis or less commonly oesophagitis. CMV enteritis is rare as is the synchronous infection with two viral agents in an immunocompromised patient having being described in a few case series only. Viral infection of the gastrointestinal tract in immunocompromised patients should be treated with systemic anti-viral medication and consideration to withdrawal of the immunosuppressive therapy if possible and appropriate. The authors highlight the need for a high suspicion of viral infection in immunosuppressed patients presenting with upper gastrointestinal bleeding.
Core tip: Viral infection of the gastrointestinal tract is a recognised complication of immunosuppression and in severe cases can lead to gastrointestinal haemorrhage. Although uncommon, synchronous infection with more than one viral agent is possible. Clinicians should have a low threshold for suspecting viral aetiology of mucosal inflammation and ulceration in immunosupressed patients and consider empirical antiviral therapy in immunosupressed patients.