P1874 - A Rare Case of Infectious Esophagitis

Reid Wasserman, DO, Shravani Reddy, MD, Diana Dougherty, MD, Subhash Garikipati, MD, Patrick Rush, MD, Shehriyar Mehershahi, MD
Carilion Clinic Virginia Tech, Roanoke, VA

Introduction: The case presented here highlights an unusual instance of bacterial esophagitis in an immunocompromised patient.

Case Description/Methods: A 67-year-old man with a history of severe peripheral arterial disease and BCR-ABL positive chronic myeloid leukemia on Nilotinib presented to the hospital with a hemoglobin of 6.3 g/dL. Of note, he recently underwent a bilateral iliofemoral thrombendarteriectomy with stent placement for critical limb ischemia and was subsequently placed on apixaban. Since this procedure, he reports intermittent melena for a month. An esophagogastroduodenoscopy revealed an esophageal ulcer at 30cm with a deep, cratered base and heaped-up borders in an irregular shape 15mm in diameter. Biopsies were obtained of the ulcer margin to rule out malignancy. Histologic analysis revealed ulcerated squamous mucosa with abundant fragments of bacterial cocci within all layers of the esophageal mucosa. Fungal organisms were not identified on periodic acid schiff-d (PAS-D) staining. He was treated with amoxicillin-clavulanate for 14 days with plans for endoscopic surveillance in 8 weeks.

Discussion: Infectious esophagitis is a condition caused by various pathogens including bacterial, viral, or fungal agents. The majority of patients are immunocompromised due to an underlying condition like human immunodeficiency virus or medications that cause granulocytopenia or lymphopenia. Candida is the most common pathogen of infectious esophagitis, followed by herpes virus or cytomegalovirus. Bacterial esophagitis is rare, composing 11-16% of infectious esophagitis. Patients present with symptoms of dysphagia and odynophagia, and rarely with ulceration and bleeding. Prompt diagnosis and appropriate antimicrobial therapy are crucial for preventing potential complications such as ulceration, bleeding, or progression to systemic infection. In conclusion, bacterial esophagitis is a rare but important consideration in immunocompromised patients with infectious esophagitis.



Disclosures:


Reid Wasserman, DO, Shravani Reddy, MD, Diana Dougherty, MD, Subhash Garikipati, MD, Patrick Rush, MD, Shehriyar Mehershahi, MD. P1874 - A Rare Case of Infectious Esophagitis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.