Cytomegalovirus (CMV)-associated gastrointestinal diseases usually occur in immunocompromised patients; however, few cases has also been described in healthy hosts despite still unclear pathological mechanisms. CMV esophagitis causes various lesions, such as erythematous mucosa, erosions, and ulcers, although such inflammatory changes can appear in superficial esophageal cancers or in surrounding areas. CMV-associated esophagitis has been also reported in cancer patients, but typically in those with advanced and/or terminal stage cancers secondary to chemoradiotherapy-induced immunosuppression or the physiologic demands of the malignancy itself. To our best knowledge, we firstly report on an immunocompetent patient subject to endoscopic submucosal dissection (ESD) for early esophageal cancer complicated with CMV infection. A 77-year-old man underwent esophagogastroduodenoscopy (EGD) at a local clinic. EGD revealed a lugol-unstained reddish lesion with whitish exudates in the middle-distal esophagus. Histological evaluation of lesion biopsy revealed atypical squamous epithelium with CMV-positive granulation tissue and aggregates of macrophages, prompting referral for further examination and treatment. Magnifying endoscopy with narrow-band imaging showed an erosive lesion with white moss in a well-demarcated brownish area with irregular mesh-like microvessels. ESD was performed for diagnosis and treatment. Histopathological examination of the resected specimen revealed superficial, moderately differentiated squamous cell carcinoma (SCC) with multiple lymphatic infiltration, and few CMV-positive cells were found in the erosive part of the SCC. Interestingly, he had no underlying conditions to predispose to CMV infection and no risk factors for esophageal cancer, other than gender and age. He received neither steroids for stricture prevention nor antiviral agents post-EGD and 4-month follow-up was negative for esophagitis. This is the first report of a case of CMV esophagitis superimposed on early esophageal cancer in an immunocompetent host and might provide valuable information for possible adverse effects of steroid administration during ESD procedures, despite their common use for prevention of post-ESD stricture.

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巨细胞病毒相关性食管炎对免疫功能正常的早期食管癌的影响

巨细胞病毒（CMV）相关的胃肠道疾病通常发生在免疫功能低下的患者中；然而，尽管病理机制尚不清楚，但在健康宿主中也很少描述这种情况。CMV食管炎会引起各种病变，例如红斑性粘膜，糜烂和溃疡，尽管这种炎症性变化可能出现在浅表食道癌或周围区域。也已经在癌症患者中报道了与CMV相关的食道炎，但通常在继放化疗引起的免疫抑制或恶性肿瘤本身的生理学要求后继发于晚期和/或晚期癌症的患者中。据我们所知，我们首先报道了一名有免疫能力的患者，因内镜下粘膜下剥离术（ESD）治疗早期食管癌并发CMV感染。一名77岁的男子在当地诊所接受了食管胃十二指肠镜检查（EGD）。EGD揭示了一个卢戈尔色斑红色的病变，在中远端食道中有白色渗出液。病灶活检的组织学评估显示，非典型鳞状上皮具有CMV阳性肉芽组织和巨噬细胞聚集体，促使其转诊作进一步检查和治疗。带有窄带成像的放大内窥镜检查显示，在界限分明的褐色区域带有不规则的网状微血管的白色苔藓样糜烂性病变。进行了ESD诊断和治疗。切除标本的组织病理学检查显示浅表，中度分化的鳞状细胞癌（SCC）伴有多处淋巴浸润，​​并且在SCC的糜烂部分发现了很少的CMV阳性细胞。有趣的是，除了性别和年龄外，他没有任何易患CMV感染的潜在条件，也没有食道癌的危险因素。他既未接受类固醇用于预防狭窄，也未接受抗病毒药物治疗，EGD后且4个月的随访对食管炎均阴性。这是首例在免疫功能正常的宿主中叠加在早期食道癌上的CMV食管炎病例，尽管在预防ESD后狭窄中已广泛使用类固醇激素，但仍可能为类固醇给药过程中的类固醇不良反应提供有价值的信息。