Acute Gastric Mucosal Lesions Associated with Cytomegalovirus Infection in a Non-Immunocompromised Host.

Abstract

A 75-year-old womanwith epigastric pain and tarry stool was admitted to our hospital, where upper gastrointestinal endoscopic study revealed multiple gastric ulcers. The endoscopic biopsy specimens obtained on the seventh hospital day disclosed a few typical intranuclear cytomegalovirus inclusions. Cytomegalovirus-DNAwas detected using polymerase chain reaction in a biopsy specimen. No immunologic abnormalities were demonstrated by any laboratory tests. While only a few cases of cytomegalovirus-associated gastric ulcer in non-immunocompromised hosts have been reported, this entity may be more frequently detected when careful histological examination is performed in the active stage rather than postponed until after healing of the ulcer. (Internal Medicine 34: 883-885, 1995)

Cytomegalovirus-associated Acute Gastric Mucosal Lesion in an Immunocompetent Host

“…Inclusion bodies may be also observed within the endothelial cells of small vessels in ulcer tissues (16) (18)(19)(20)(21)(22). However, it is sometimes difficult to detect them in specimens from immunocompetent hosts.…”

“…However, it is sometimes difficult to detect them in specimens from immunocompetent hosts. In those cases, molecular technology including in situ hybridization (23) and/or the polymerase chain reaction (PCR) procedure (24) is necessary to prove CMV infection (21,22).…”

“…It is of interest that most of the patients with CMVassociated AGML who were immunocompetent individuals did not require an antiviral treatment such as ganciclovir (18)(19)(20)(21)(22), because CMV-associated ulcers in the GI tracts are often self limited (11,25) (26).…”

Cytomegalovirus-Associated Protein-Losing Gastropathy (Menetrier’s Disease) in Childhood

“…Although the mechanism is not clearly understood, it has been reported in a few studies that TGF-α is immunoreactively increased by CMV (5). CMV infection usually gives signs in the gastric fundus and corpus and may lead to wall thickening, ulceration, hemorrhage, and perforation (9). Characteristic histologic symptoms include hypertrophy of the gastric mucosa associated with foveolar hyperplasia.…”

“…Histopathologically, chronic pan-mucosal gastritis and, in tissue, CMV positive intraepithelial inclusion bodies were observed. It has been stated that the reason for this observation is that CMV is demonstrative in the early stages but cannot be seen in later stages (9). Gastrointestinal CMV infection is mostly seen in patients with immune deficiency.…”