Cytomegalovirus gastritis: Clinicopathological profile

Abstract

Background: Cytomegalovirus (CMV) gastritis is occasionally reported in case reports and limited case series. Up to now, it is the largest and most comprehensive retrospective study of CMV gastritis. Methods: All patients who were histologically diagnosed with CMV gastritis at Linkou Chang Gung Memorial Hospital between January 20 0 0 and April 2020 were included. Patients were divided into two groups according to immunity. Between-group differences in characteristics, manifestations, endoscopic features, prognostic factors, and outcomes were analyzed. The main endpoint was 3-month mortality. Results: A total of 54 patients (34 immunocompromised, 20 immunocompetent) were enrolled. Common presentations included gastrointestinal bleeding (35.2%), abdominal pain (33.3%) and fever (31.5%). The endoscopic features included ulcer (88.9%) and inflammation (11.1%). The 3-month mortality rate was 20.4% and overall mortality rate was 40.7%. Acute kidney injury was the only independent risk factor for 3-month mortality (OR 53.89, 95%CI 1.56-1861.73, p = 0.027). Anti-viral therapy and host immune status did not affect 3-month mortality. Conclusion: Both immunocompromised and immunocompetent patients with CMV gastritis have high mortality rates, without significant between-group differences. Acute kidney injury is the only independent predictive factor for 3-month mortality. Prevention of acute kidney injury may possibly improve the 3-month mortality rate.

Cytomegalovirus Diseases of the Gastrointestinal Tract

“…The two latest retrospective studies that enrolled 213 and 173 patients with positive H&E or IHC staining in Thailand found that antiviral treatment was the only protective factor that improved patient survival [7,9]. However, in our previous studies on CMV gastritis, enteritis, and colitis, antiviral therapy had no significant impact on in-hospital survival [8,14,15].…”

“…Patients were defined as "immunocompromised" if they were recipients of solid organ or hematopoietic stem cell transplant or were documented to have primary immunodeficiency, human immunodeficiency virus infection, exposure to chemotherapeutic agents or radiotherapy within the last 6 months, and/or use immunosuppressants (including corticosteroids (oral or intravenous administration, ≥20 mg/day of prednisolone or any equivalent for >2 weeks)) [8,14,15].…”

“…However, IHC staining has a higher sensitivity and specificity than routine HE staining [5,6]. Emerging research has shown that CMV diseases involved both immunocompromised and immunocompetent hosts [2,[7][8][9]. The whole alimentary tract can be infected, but leading sites are the colon and esophagus [10].…”

Clinical manifestations, risk factors, and prognostic factors of cytomegalovirus enteritis

“…CMV enteritis is a rare but fatal disease that has been under diagnosed. It is not only an opportunistic infection in immunocompromised patients, but also affects immunocompetent individuals [ 2 , 3 , 10 , 14 ]. Despite the development of small intestinal endoscopies, such as capsule endoscopy, single-balloon enteroscopy, and double-balloon enteroscopy, diagnosis of CMV enteritis is still difficult due to critical general condition of the patients, various clinical presentations, and expensive procedure fees.…”

“…It causes not only subclinical infections but also serious tissue invasive diseases. The gastrointestinal (GI) tract is a common location for CMV infection, both in immunocompromised as well as immunocompetent patients; it has variable clinical presentations and a high mortality rate [ 2 – 5 ]. Research of small intestinal CMV disease is relatively rare compared to other GI tract CMV diseases possibly due to difficult tissue sampling.…”