Korean J Helicobacter Up Gastrointest Res.  2015 Mar;15(1):44-48. 10.7704/kjhugr.2015.15.1.44.

A Case of Cytomegalovirus-associated Giant Gastric Ulcer in a Patient Who Healed by Discontinuing Immunosuppressive Therapy

Affiliations
  • 1Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea. bangbu@inha.ac.kr
  • 2Department of Pathology, Inha University School of Medicine, Incheon, Korea.
  • 3Department of Internal Medicine, Pohang St. Mary's Hospital, Pohang, Korea.

Abstract

Cytomegalovirus (CMV) is not a rare infection and is frequently observed in immuoncompromised patients. CMV infection is usually asymptomatic in immunocompetent patients however it can be a major cause of morbidity and mortality in immunocompromised patients. The diagnosis of CMV gastric ulcer is not easy because of the absence of characteristic endoscopic features and the difficulty in the identification of infection by routine histologic examinations. We experienced a case of CMV-associated giant gastric ulcer in a patient receiving immunosuppressive therapy. She was a 45-year-old woman with dermatomyositis and had received steroid therapy to control her disease. Epigastric pain developed during therapy and upper endoscopy revealed a gastric ulcer. Despite proton pump inhibitor therapy, her epigastric pain aggravated and follow-up endoscopy revealed a huge gastric ulcer approximately 10 cm in diameter. Histologic findings showed intracellular inclusion bodies after immunostaining which confirmed CMV-associated gastric ulcer. Steroid therapy was discontinued and she received proton pump inhibitors without antiviral agents. Her symptoms improved and follow-up endoscopy revealed successful healing of the CMV-associated gastric ulcer. If an unusual gastric ulcer develops in the immunocompromised patients, CMV gastric ulcer should be suspected and examination for inclusion bodies using CMV immunostaining should be considered.

Keyword

Cytomegalovirus; Stomach ulcer; Steroids; Immunosuppressive agents; Dermatomyositis

MeSH Terms

Antiviral Agents
Cytomegalovirus
Dermatomyositis
Diagnosis
Endoscopy
Female
Follow-Up Studies
Glycogen Storage Disease Type VI
Humans
Immunocompromised Host
Immunosuppressive Agents
Inclusion Bodies
Middle Aged
Mortality
Proton Pump Inhibitors
Proton Pumps
Steroids
Stomach Ulcer*
Antiviral Agents
Immunosuppressive Agents
Proton Pump Inhibitors
Proton Pumps
Steroids
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