Suspected Cytomegalovirus Esophagitis with Upper Gastrointestinal Bleed in a Patient with Waldenstrom Macroglobulinemia

Cytomegalovirus (CMV) esophagitis is a commonly encountered entity in immune-compromised hosts, usually presenting with complaints of odynophagia and dysphagia. Rarely, CMV can cause deep esophageal ulcerations and can present with life-threatening gastrointestinal (GI) bleeding in the form of hematemesis. We hereby present a rare case of CMV esophagitis presenting as life-threatening GI bleed and impending esophageal perforation. We emphasize the fact that not all patients need a histological diagnosis, which could be time-consuming in some cases and in patients with favorable history and other supportive evidence, diagnosis can be made without biopsy as well. Timely endoscopy with appropriate intervention and antiviral therapy can be lifesaving. We highlight the differentials to be thought of when encountered with such clinical presentation and various feasible endoscopic options available.