title: Rare cause of odynophagia: Giant esophageal ulcer.
abstract: Gastrointestinal complications are a frequent cause of morbidity after transplantation and may affect up to 40% of kidney transplant recipients. Here we report a rare case of idiopathic giant esophageal ulcer in a kidney transplant recipient. A 37-year-old female presented with a one-week history of odynophagia and weight loss. Upon admission, the patient presented cold sores, and a quantitative cytomegalovirus polymerase chain reaction was positive (10(5) copies/mL). An upper endoscopy demonstrated the presence of a giant ulcer. Serological test and tissue biopsies were unable to demonstrate an infectious origin of the ulcer. Immunosuppression was reduced and everolimus was introduced. An empirical i.v. therapy with acyclovir was started, resulting in a dramatic improvement in symptoms and complete healing of the ulcer. Only two cases of idiopathic giant esophageal ulcer in kidney transplant recipients have been reported in the literature; in both cases, steroid therapy was successful without recurrence of symptoms or endoscopic findings. However, this report suggests that correction of immune imbalance is mandatory to treat such a rare complication.
authors.affiliation: Massimiliano Veroux, Daniela Corona, Alessia Giaquinta, Pierfrancesco Veroux, the Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, 95123 Catania, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Veroux
authors.affiliation: Massimiliano Veroux, Daniela Corona, Alessia Giaquinta, Pierfrancesco Veroux, the Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, 95123 Catania, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Aprile
authors.affiliation: Massimiliano Veroux, Daniela Corona, Alessia Giaquinta, Pierfrancesco Veroux, the Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, 95123 Catania, Italy.
authors.forename: Francesca F
authors.initials: FF
authors.lastname: Amore
authors.affiliation: Massimiliano Veroux, Daniela Corona, Alessia Giaquinta, Pierfrancesco Veroux, the Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, 95123 Catania, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Corona
authors.affiliation: Massimiliano Veroux, Daniela Corona, Alessia Giaquinta, Pierfrancesco Veroux, the Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, 95123 Catania, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Giaquinta
authors.affiliation: Massimiliano Veroux, Daniela Corona, Alessia Giaquinta, Pierfrancesco Veroux, the Vascular Surgery and Organ Transplant Unit, Department of Medical and Surgical Sciences and Advanced Technologies, University Hospital of Catania, 95123 Catania, Italy.
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Veroux
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D001706:Biopsy; D003680:Deglutition Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D057915:Drug Substitution; D004359:Drug Therapy, Combination; D004935:Esophageal Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D004945:Esophagoscopy; D000068338:Everolimus / Q000008:administration & dosage; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects*; D016896:Treatment Outcome; D014456:Ulcer / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology*; D015431:Weight Loss; D014945:Wound Healing
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D000068338:Everolimus
keywords: Acyclovir; Endoscopy; Gastrointestinal complications; Idiopathic; Kidney transplantation; Steroid