Veroux M, Aprile G, Amore FF, Corona D, Giaquinta A, Veroux P. Rare cause of odynophagia: Giant esophageal ulcer. World J Gastroenterol 2016; 22(14): 3875-3878 [PMID: 27076774 DOI: 10.3748/wjg.v22.i14.3875]
Corresponding Author of This Article
Massimiliano Veroux, MD, PhD, FEBS, Associate Professor of Surgery, the Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Via Santa Sofia, 84, 95123 Catania, Italy. veroux@unict.it
Research Domain of This Article
Transplantation
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Apr 14, 2016; 22(14): 3875-3878 Published online Apr 14, 2016. doi: 10.3748/wjg.v22.i14.3875
Rare cause of odynophagia: Giant esophageal ulcer
Massimiliano Veroux, Giuseppe Aprile, Francesca F Amore, Daniela Corona, Alessia Giaquinta, Pierfrancesco Veroux
Massimiliano Veroux, Daniela Corona, Alessia Giaquinta, Pierfrancesco Veroux, the Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, 95123 Catania, Italy
Giuseppe Aprile, Endoscopy Unit, Department of Surgical Specialties, University Hospital of Catania, 95123 Catania, Italy
Francesca F Amore, Pathology Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, 95123 Catania, Italy
Author contributions: Veroux M and Veroux P designed the report; Aprile G performed the endoscopic procedures; Amore FF performed the histological analysis and immunohistochemical studies; Corona D and Giaquinta A collected the patient’s clinical data; Veroux M analyzed the data and wrote the paper.
Supported by Italian Ministry of Health, No. PE-2011-02350135; and University of Catania, No. FIR-2014.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at University of Catania.
Informed consent statement: The patient involved in this study gave her written informed consent authorizing use and disclosure of her protected health information.
Conflict-of-interest statement: All the authors have no conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Massimiliano Veroux, MD, PhD, FEBS, Associate Professor of Surgery, the Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, Via Santa Sofia, 84, 95123 Catania, Italy. veroux@unict.it
Telephone: +39-95-3782384 Fax: +39-95-3782358
Received: August 28, 2015 Peer-review started: August 31, 2015 First decision: September 29, 2015 Revised: October 22, 2015 Accepted: December 12, 2015 Article in press: December 14, 2015 Published online: April 14, 2016 Processing time: 213 Days and 21.1 Hours
Abstract
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 (105 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.
Core tip: Gastrointestinal complications after kidney transplantation are common and may be associated to an increased risk of serious post-transplant morbidity. Giant esophageal ulcers are very rare and the diagnosis of causality is often delayed. This case illustrates the clinical management of an idiopathic giant ulcer, suggesting the possible role of innate immunity imbalance in the pathogenesis of this rare clinical finding.
