UPPER GI BLEEDING WITH HEMORRHAGIC SHOCK CAUSED BY INFECTIOUS ESOPHAGITIS.

Massive gastrointestinal bleeding is rarely caused by infectious etiologies especially with esophageal localization. Even if Cytomegalovirus infection (CMV) is not often encountered in the clinical practice, it has to be taken into account when the cause of GI hemorrhage is not obvious. We report a case of a 53 years old, male patient, with diabetes who is admitted in the hospital for cellulitis of the left calf and who developed massive hematemesis with no obvious source at the upper GI endoscopy. The patient was treated conservatory with PPI and blood transfusions but he repeated the hemorrhage after 5 days with severe hypotension and a drop of hemoglobin to 6 g/dl. The second endoscopy revealed massive clots in the esophagus with erythema and deep ulcers underneath while the stomach and duodenum were normal. Multiple biopsies from esophageal mucosa were taken. We suspected viral esophagitis with CMV and we started empiric treatment with valganciclovir for 21 days with favorable clinical course. The infection was then confirmed by the pathology department and the immunohistochemical studies. The control endoscopy after one month showed healed esophageal ulcers with minimal residual lesions. [ABSTRACT FROM AUTHOR]