Catastrophic gastrointestinal complication of systemic immunosuppression

Figure 1 Endoscopic appearance. A: Upper oesophagus showing raised whitish plaques which were thought to be viral in origin at the time of endoscopy; B: Lower oesophagus showing severe confluent oesophagitis with necrosis and active bleeding; C: Second part of duodenum showing a non specific duodenitis.

Figure 2 Histology and immunohistochemical staining. A: Histology of upper oesophageal biopsies; B: Immunohistochemical staining of oesophageal biopsies showing herpes simplex virus; C: Histology of duodenal biopsies; D: Immunohistochemical staining of duodenal biopsies showing cytomegalovirus.