Scientific Development Research
Scientific Development Research . 2025; 5: (1) ; 10.12208/j.sdr.20250005 .
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1 华中科技大学同济医学院附属协和医院肿瘤中心 湖北武汉
2 华中科技大学同济医学院附属协和医院放射肿瘤研究所 湖北武汉
*通讯作者： 张盛,单位： 华中科技大学同济医学院附属协和医院肿瘤中心 湖北武汉 华中科技大学同济医学院附属协和医院放射肿瘤研究所 湖北武汉；
本研究报道了一例晚期食管癌患者在卡瑞利珠单抗免疫维持治疗期间发生巨细胞病毒食管炎的病例，并对相关文献进行了回顾。患者在接受卡瑞利珠单抗治疗14次后出现发热、吞咽痛、吞咽困难，经胃镜检查和病理活检确诊为巨细胞病毒食管炎。给予更昔洛韦抗病毒治疗后症状缓解，CMV抗原血症转为阴性，食道溃疡改善。本病例强调了在食管癌免疫治疗过程中需警惕巨细胞病毒食管炎这一罕见但严重的并发症。
This study reports a case of cytomegalovirus esophagitis in a patient with advanced esophageal cancer during maintenance immunotherapy with carrelizumab, and reviews the relevant literature. The patient developed fever, odynophagia, and dysphagia after 14 treatments with carrelizumab, and was diagnosed with cytomegalovirus esophagitis by gastroscopy and pathological biopsy. After antiviral treatment with ganciclovir, the symptoms were relieved, CMV antigenemia became negative, and esophageal ulcers improved. This case emphasizes the need to be vigilant against cytomegalovirus esophagitis, a rare but serious complication during immunotherapy for esophageal cancer.
[1] Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-63.
[2] Hoversten P, Kamboj AK, Wu TT, Katzka DA. Risk Factors, Endoscopic Features, and Clinical Outcomes of Cytomegalovirus Esophagitis Based on a 10-year Analysis at a Single Center. Clin Gastroenterol Hepatol. 2020; 18(3):736-8.
[3] Aizawa R, Matsumoto S, Uneno Y, Nishikawa Y, Ozaki Y, Mori Y, et al. Severe esophagitis associated with cytomegalovirus during concurrent chemoradiotherapy for esophageal cancer. Jpn J Clin Oncol. 2017;47(9):885-8.
[4] Umemoto K, Kojima Y, Nagata N, Yokoi C, Sakurai T, Kobayakawa M, et al. Cytomegalovirus esophagitis developing during chemoradiotherapy for esophageal cancer: two case reports. J Med Case Rep. 2016;10(1):259.
[5] Murata T. Human Herpesvirus and the Immune Checkpoint PD-1/PD-L1 Pathway: Disorders and Strategies for Survival. Microorganisms. 2021;9(4).
[6] Griffiths P, Reeves M. Pathogenesis of human cytomegalovirus in the immunocompromised host. Nat Rev Microbiol. 2021;19(12):759-73.
[7] Ohnuma H, Sato Y, Takayama T, Takimoto R, Abe T, Hagiwara S, et al. Esophageal cancer complicated by cytomegalovirus esophagitis during chemoradiotherapy: case report. Gastrointest Endosc. 2003;57(4):622-6.
[8] Sezgin E, An P, Winkler CA. Host Genetics of Cytomegalovirus Pathogenesis. Front Genet. 2019;10:616.
[9] Herbein G. Tumors and Cytomegalovirus: An Intimate Interplay. Viruses. 2022;14(4).
[10] Gueguen J, Bailly E, Machet L, Miquelestorena-Standley E, Stefic K, Gatault P, et al. CMV disease and colitis in a kidney transplanted patient under pembrolizumab. Eur J Cancer. 2019;109:172-4.
[11] Murakami D, Harada H, Yamato M, Amano Y. Cytomegalovirus-associated esophagitis on early esophageal cancer in immunocompetent host: a case report. Gut Pathog. 2021;13(1):24.
[12] Hu L, Wen Z, Chen J, Chen Y, Jin L, Shi H, et al. The cytomegalovirus UL146 gene product vCXCL1 promotes the resistance of hepatic cells to CD8(+) T cells through up-regulation of PD-L1. Biochem Biophys Res Commun. 2020;532(3):393-9.
[13] Benedict CA, Loewendorf A, Garcia Z, Blazar BR, Janssen EM. Dendritic cell programming by cytomegalovirus stunts naive T cell responses via the PD-L1/PD-1 pathway. J Immunol. 2008;180(7):4836-47.
[14] Parry HM, Dowell AC, Zuo J, Verma K, Kinsella FAM, Begum J, et al. PD-1 is imprinted on cytomegalovirus-specific CD4+ T cells and attenuates Th1 cytokine production whilst maintaining cytotoxicity. PLoS Pathog. 2021;17(3):e1009349.
[15] Erkes DA, Smith CJ, Wilski NA, Caldeira-Dantas S, Mohgbeli T, Snyder CM. Virus-Specific CD8(+) T Cells Infiltrate Melanoma Lesions and Retain Function Independently of PD-1 Expression. J Immunol. 2017; 198(7): 2979-88.