CMV esophagitis

by Jason Wasserman MD PhD FRCPC
April 24, 2024


CMV esophagitis is a medical condition caused by cytomegalovirus (CMV) infection of the esophagus. The infection leads to inflammation, which damages tissue inside the esophagus.

What causes CMV esophagitis?

CMV esophagitis is caused by infection of the cells inside the esophagus with cytomegalovirus (CMV).

Who is at risk for developing CMV esophagitis?

People who have a weakened immune system are at risk for developing CMV esophagitis. A weakened immune system can be caused by medications such as those taken after a solid organ or bone marrow transplant, corticosteroids or immune modulators, and HIV infection. CMV esophagitis is rare in people with a normal immune system.

What are the symptoms of CMV esophagitis?

The most common symptoms of CMV esophagitis are difficulty swallowing or pain when swallowing foods or liquids.

How is CMV esophagitis diagnosed?

The diagnosis of CMV esophagitis can be made after your doctor examines the inside of your esophagus with a camera called an endoscope. During the examination, small white abnormal areas of tissue called ulcers may be seen on the inside of the esophagus. A procedure called a biopsy may be performed to remove a small piece of tissue from the affected area. The tissue will be sent to a pathologist for examination under the microscope.

What does CMV esophagitis look like under the microscope?

The inner lining of the esophagus is covered by squamous cells, which form a protective layer called the epithelium. Directly beneath this epithelial layer lies a thin layer of connective tissue known as the lamina propria. This layer houses various cell types, including endothelial cells that line blood vessels, and fibroblasts, which provide structural support to the surrounding cells.

In cases of CMV esophagitis, both endothelial cells and fibroblasts can become infected. Under a microscope, these infected cells display distinctive changes, such as an unusually large nucleus—the part of the cell that contains genetic material. This enlarged nucleus often contains blue or purple dots known as intranuclear inclusions, which are indicative of viral infection.

Additionally, inflammatory cells like neutrophils, lymphocytes, and histiocytes are commonly observed surrounding the infected cells, indicating the body’s immune response to the infection.

What other tests may be performed to confirm the diagnosis?

Your pathologist may perform a test called immunohistochemistry (IHC) which allows them to see the virus inside infected cells. This confirms the diagnosis of CMV esophagitis.

About this article

Doctors wrote this article to help you read and understand your pathology report. Contact us with any questions about this article or your pathology report. Read this article for a more general introduction to the parts of a typical pathology report.

Other helpful resources

Atlas of Pathology
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