Bacterial Esophagitis in Immunocompromised Patients

• We studied the clinical and pathologic features of bacterial esophagitis in three index cases identified by endoscopic biopsy and in 20 autopsy cases. Fourteen of the 23 patients had malignant hematologic conditions, aplastic anemia, or solid tumors; ten were profoundly neutropenic (white blood cell count, <100/mm³ [<0.1 × 10⁹/L]). The organisms involved in bacterial esophagitis were gram-positive cocci in 14, gram-negative bacilli in three, mixed gram-negative bacilli and gram-positive cocci in five, and gram-positive bacilli in one. Four patients had bacteremic bacterial esophagitis; all were immunocompromised, three by profound neutropenia and one by gestational prematurity. Bacteria causing bacteremic bacterial esophagitis were all gram-positive: viridans-group streptococci, Staphylococcus aureus, Staphylococcus epidermidis, and Bacillus species. Our study suggests that bacterial esophagitis is more common than has been recognized in the past and should be considered as a potential source of bacteremia in immunocompromised patients.