Rare cause of odynophagia: Giant esophageal ulcer.
Gastrointestinal complications are a frequent cause of morbidity after transplantation and may affect up to 40% of kidney transplant recipients. Here we report a rare case of idiopathic giant esophageal ulcer in a kidney transplant recipient. A 37-year-old female presented with a one-week history of odynophagia and weight loss. Upon admission, the patient presented cold sores, and a quantitative cytomegalovirus polymerase chain reaction was positive (10(5) copies/mL). An upper endoscopy demonstrated the presence of a giant ulcer. Serological test and tissue biopsies were unable to demonstrate an infectious origin of the ulcer. Immunosuppression was reduced and everolimus was introduced. An empirical i.v. therapy with acyclovir was started, resulting in a dramatic improvement in symptoms and complete healing of the ulcer. Only two cases of idiopathic giant esophageal ulcer in kidney transplant recipients have been reported in the literature; in both cases, steroid therapy was successful without recurrence of symptoms or endoscopic findings. However, this report suggests that correction of immune imbalance is mandatory to treat such a rare complication.
['Veroux|Massimiliano|M|', 'Aprile|Giuseppe|G|', 'Amore|Francesca F|FF|', 'Corona|Daniela|D|', 'Giaquinta|Alessia|A|', 'Veroux|Pierfrancesco|P|']
D000328:Adult D000998:Antiviral Agents D001706:Biopsy D003680:Deglutition Disorders D057915:Drug Substitution D004359:Drug Therapy, Combination D004935:Esophageal Diseases D004945:Esophagoscopy D000068338:Everolimus D005260:Female D006801:Humans D016867:Immunocompromised Host D007166:Immunosuppressive Agents D016030:Kidney Transplantation D016896:Treatment Outcome D014456:Ulcer D015431:Weight Loss D014945:Wound Healing
Gastrointestinal complications Kidney transplantation Idiopathic Endoscopy Acyclovir Steroid