Postural Epigastric Pain as a Sign of Cytomegalovirus Gastritis in Renal Transplant Recipients: A Case-Based Review

Li, W.; Fan, Hong; Li, Yi-Ping

doi:10.1016/j.transproceed.2009.05.034

Cited by 10 publications

(8 citation statements)

References 7 publications

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“…She also had endoscopic biopsy to prove histological CMV gastritis and treated with ganciclovir. 3 More recently Li et al 5 also reported a 34-year-old renal transplant recipient who presented with postural epigastric pain and was found to have biopsy-proven CMV gastritis.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] Although not proved yet, postural epigastric pain can be regarded as a unique symptom of CMV gastritis. Renal transplant patients presenting with postural epigastric pain which is not relieved with acid suppression should raise suspicion of CMV gastritis and this has to be confirmed by endoscopy and biopsy.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 CMV gastritis is of certain importance because of its reported association with postural epigastric pain. [3][4][5] Postural epigastric pain is an uncommon symptom and is hardly acquired unless specifically asked to the patient. It can be described as epigastric pain relieved in supine position, aggravated while sitting, and further increased with standing or walking.…”

Section: Introductionmentioning

confidence: 99%

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Postural Epigastric Pain: A Challenging Symptom for Cytomegalovirus (CMV) Gastritis

et al. 2012

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Postural epigastric pain is an uncommon symptom and is hardly acquired unless specifically asked to the patient. Here we present a cytomegalovirus (CMV) gastritis case in a renal transplant patient with postural epigastric pain. A 36-year-old male was admitted to our clinic on the 50th day of renal transplantation with postural epigastric pain. All investigations were unremarkable except biopsy-proven CMV gastritis and increased CMV viral load. The patient was free of symptom after ganciclovir treatment. Postural epigastric pain has not been described together with a clinical entity. Although not proved yet, it can be regarded as a unique symptom of CMV gastritis. Renal transplant patients presenting with postural epigastric pain which is not relieved with acid suppression should raise suspicion of CMV gastritis and this has to be confirmed by endoscopy and biopsy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Postural Epigastric Pain: A Challenging Symptom for Cytomegalovirus (CMV) Gastritis

et al. 2012

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“…Esophagitis in SOT patients may be severe or atypical, and has been reported to cause acute esophageal necrosis (black esophagus) in a renal transplant recipient [8,9]. Other manifestations of upper gastrointestinal tract luminal disease such as gastritis or stomach mass due to CMV have been described in SOT recipients [10,11]. Given the wide clinical spectrum of disease, upper gastrointestinal tract symptoms such as dysphagia, odynophagia, epigastric pain, nausea, or vomiting should prompt endoscopic evaluation in this patient population.…”

Section: Clinical Manifestations Of Gastrointestinal Tract CMV Infectionmentioning

confidence: 99%

Update on Cytomegalovirus Infections of the Gastrointestinal System in Solid Organ Transplant Recipients

Lemonovich

Watkins

2011

Curr Infect Dis Rep

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Cytomegalovirus (CMV) infection of the gastrointestinal tract is the most common manifestation of tissue-invasive CMV disease, and is a significant cause of morbidity and mortality in the solid organ transplantation (SOT) recipient. In addition to the direct effects of the infection, its indirect effects on allograft function, risk for other opportunistic infections, and mortality are significant in this population. The most common clinical syndromes are esophagitis, colitis, and hepatitis; however, infection can occur anywhere in the gastrointestinal tract. Diagnosis is usually by histopathology or viral culture of tissue specimens; molecular assays also often have a role. Antivirals are the cornerstone of therapy for gastrointestinal tract CMV disease and complications such as recurrent infection and antiviral resistance are not uncommon. Prevention with antiviral prophylaxis or preemptive therapy is important. This review summarizes recent data regarding the clinical manifestations, diagnosis, treatment, and prevention of gastrointestinal tract CMV infection in the SOT population.

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“…The colon and stomach are the most common sites of its gastroin testinal infection. Although postural epigastric pain has been described as a sign of CMV gastritis [2] , symptoms of …”

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confidence: 99%

Cytomegalovirus gastritis

Hokama

Taira²,

Yamamoto³

et al. 2010

WJGE

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Cytomegalovirus (CMV) has been increasingly recognized as an important common pathogen in an immunocompromised state. The colon and stomach are the most common sites of its gastrointestinal infection. Symptoms of CMV gastritis are usually nonspecific and include epigastric pain, fever, nausea and bleeding. Endoscopic features are quite variable and include macroscopically normal mucosa, diffuse erythema, nodules, pseudotumors, erosions and ulcers. The bioptic detection of intranuclear inclusions is the hallmark of CMV infection. Most gastrointestinal CMV infection responds well to ganciclovir. We present endoscopic and histopathological features of CMV gastritis in a 71 year old woman receiving long-term prednisolone for pemphigus vulgaris. TO THE EDITORA 71 year old woman who had been receiving long-term prednisolone for pemphigus vulgaris underwent upper gastrointestinal endoscopy for screening. She denied ha ving abdominal symptoms. On examination, there was no tenderness on abdominal palpation and normal bowel sounds. Endoscopic examination revealed numerous patchy erythemas in the gastric body ( Figure 1A). The erythema was slightly depressed ( Figure 1B). The histopathological examination of the lesion showed large epithelial cells with characteristic "owl's eye" eosinophilic intranuclear inclusion body surrounded by a clear halo ( Figure 1C) compatible with cytomegalovirus (CMV) infection. Positive immunostaining for CMV antigens confirmed the diagnosis of CMV gastritis ( Figure 1D). The gastritis improved with the treatment of ganciclovir.CMV has been increasingly recognized as an important common pathogen in an immunocompromised state including those caused by immunosuppressive medications, cancer chemotherapy, transplant recipients, aging and human immunodeficiency virus infection [1] . The colon and stomach are the most common sites of its gastroin testinal infection. Although postural epigastric pain has been described as a sign of CMV gastritis [2] , symptoms of

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Postural Epigastric Pain as a Sign of Cytomegalovirus Gastritis in Renal Transplant Recipients: A Case-Based Review

Cited by 10 publications

References 7 publications

Postural Epigastric Pain: A Challenging Symptom for Cytomegalovirus (CMV) Gastritis

Postural Epigastric Pain: A Challenging Symptom for Cytomegalovirus (CMV) Gastritis

Update on Cytomegalovirus Infections of the Gastrointestinal System in Solid Organ Transplant Recipients

Cytomegalovirus gastritis

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