We report the case of an 88-year-old woman with rheumatic polymyalgia treated with oral corticosteroids (prednisone 30 mg/24 h) who was admitted to our hospital for dysphagia, odynophagia and asthenia of two weeks duration.
A few days before admission, the patient had experienced an episode of atypical chest pain radiating to the neck, with normal cardiac examination.
One day after admission the patient developed sepsis without hemodynamic instability or anemia.
An upper endoscopy showed a hole partially covered with fibrin with an apparently blind end located in the cervical esophagus.
Biopsies were taken from the edges.
Placement chart and computed tomography showed a fistula in the lateral face of the cervical esophagus in communication with a pseudoaneurysm filled with oral contrast (in the mapping).
Biopsies showed the presence of cytopathic effect characteristic of CMV.
Once the diagnosis of CMV infection was established, valganvir therapy (900 mg/12 h) was started, reducing the prednisone dose.
The patient experienced significant clinical improvement within a few days.
Twelve weeks later she underwent a new endoscopy, which showed complete healing of the fistula.
