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Sequential infection by herpes simplex virus, Candida species, and Cytomegalovirus species in esophagus

Published:April 14, 2019DOI:https://doi.org/10.1016/j.gie.2019.04.210
      A 63-year-old man presented with odynophagia and retrosternal pain. Previously, prednisolone and cyclophosphamide were administered for severe interstitial pneumonia. The first EGD showed diffuse maplike erosions with exfoliation of the epithelium in the distal esophagus (A). Histologic analysis revealed multinucleated cells with ground-glass nuclei (B, arrowheads). His serum herpes simplex virus–immunoglobulin-M level was elevated to 4.49 (antibody index). Acyclovir was administered for herpes simplex virus–induced esophagitis, and the symptoms improved. In 9 months, he experienced recurrence of odynophagia and underwent a second EGD.
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