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• W2321769980 abstract "Esophageal intramural pseudodiverticulosis (EIP) is a benign condition that presents as dysphagia in more than 80% of patients.1Lopes de Oliveira L. Carneiro F.O. Baba E.R. et al.Esophageal intramural pseudodiverticulosis: a rare endoscopic finding.Case Rep Med. 2013; 2013Google Scholar The condition is rare and pathogenesis is caused by either obstruction of excretory ducts or motor disorders of the esophageal wall that lead to ductal dilation.2Young E.C. Hwang S. Jung K.S. et al.A case of esophageal intramural pseudodiverticulosis.Gut Liver. 2011; 5: 93-95Google Scholar The association of EIP with human immunodeficiency virus (HIV) is rare and has been reported on only a few occasions in the literature, but is a logical one given the propensity of HIV patients to develop esophageal Candidiasis, and the association of this fungal infection with the development of pseudodiverticula. We describe an interesting case of an HIV patient with complaints of dysphagia found to have EIP. Our patient was a 38-year-old man with a long-standing history of HIV/acquired immune deficiency syndrome with a CD4 count of 33 who presented with chest and abdominal pain. The patient had been experiencing progressive epigastric pain over the preceding 2 weeks that was burning, sharp, and without radiation. He reported dysphagia associated with solid foods at the approximate level of the sternal notch, which often was followed by vomiting. Initial investigation with an esophagram and CT chest showed what was described as massive esophageal ulcers with fistulous communications and numerous pseudodiverticula (Figures A and B). Upper endoscopy was performed, and was significant for multiple pseudodiverticula without any other gross abnormalities, including any strictures or ulcerations (Figures C and D). Pathology from biopsy specimens taken showed chronic inflammatory changes consistent with pseudodiverticula formation, but no evidence of Candidiasis, cytomegalovirus, herpes simplex virus or any other invasive pathology. He was placed on a proton pump inhibitor and kept on a soft mechanical diet. He reported significant improvement of symptoms at the follow-up clinic appointment. Esophageal intramural pseudodiverticulosis was first described by Mendl in 1960,3Mendl K. Tanner C.H. Intramural diverticulosis of the oesophagus and Rokitansky-Aschoff sinuses in the gall-bladder.Br J Radiol. 1960; 33: 496-501Google Scholar presenting as multiple flask-shaped dilations in the wall of the esophagus. Visualization by esophagoscopy occurs in only approximately 20% of cases and is much more common on esophagram or computed tomography.1Lopes de Oliveira L. Carneiro F.O. Baba E.R. et al.Esophageal intramural pseudodiverticulosis: a rare endoscopic finding.Case Rep Med. 2013; 2013Google Scholar, 2Young E.C. Hwang S. Jung K.S. et al.A case of esophageal intramural pseudodiverticulosis.Gut Liver. 2011; 5: 93-95Google Scholar Chronic alcoholism, diabetes mellitus, esophageal Candidiasis, and reflux disease often are reported in association with EIP, however, an association with HIV has been described only a few times in the literature.1Lopes de Oliveira L. Carneiro F.O. Baba E.R. et al.Esophageal intramural pseudodiverticulosis: a rare endoscopic finding.Case Rep Med. 2013; 2013Google Scholar, 2Young E.C. Hwang S. Jung K.S. et al.A case of esophageal intramural pseudodiverticulosis.Gut Liver. 2011; 5: 93-95Google Scholar, 4Chiba T. Iljima K. Koike T. et al.A case of severe esophageal intramural pseudodiverticulosis whose symptoms were ameliorated by oral administration of anti-fungal medicine.Case Rep Gastroenterol. 2012; 6: 103-110Google Scholar, 5Koyama S. Watanabe M. Iijima T. Esophageal intramural pseudodiverticulosis (diffuse type).J Gastroenterol. 2002; 37: 644-648Google Scholar We believe that difficulty visualizing pseudodiverticula on esophagogastroduodenoscopy and their resolution with treatment of the inciting pathology has led to under-reporting of this association in the past. The extent of the tract formation seen on our patient’s esophagram was very unique because the outpouchings generally have been reported on the order of millimeters and not centimeters, as seen in our case." @default.
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• W2321769980 date "2016-08-01" @default.
• W2321769980 modified "2023-09-25" @default.
• W2321769980 title "Esophageal Intramural Pseudodiverticulosis With Tract Formation, Without Evidence of Candidiasis, in a Patient With HIV Infection" @default.
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• W2321769980 doi "https://doi.org/10.1016/j.cgh.2016.03.014" @default.
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