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Jalil Z, Zaman Z, Lund S, Seetlani NK, Arshad S. Extensive Cytomegalovirus Gastroduodenitis Causing Gastric Outlet Obstruction in an Immunocompetent Patient. ACG Case Rep J 2024; 11:e01420. [PMID: 39040956 PMCID: PMC11262813 DOI: 10.14309/crj.0000000000001420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 05/20/2024] [Accepted: 05/30/2024] [Indexed: 07/24/2024] Open
Abstract
Cytomegalovirus (CMV) has been extensively researched in immunocompromised people, causing conditions such as colitis, retinitis, esophagitis, encephalitis, and pneumonitis. However, there are limited data on how the disease presents itself in immunocompetent hosts, apart from a self-limited mononucleosis-like syndrome. This case report presents CMV gastroenteritis causing gastroduodenal obstruction in an immunocompetent woman. It is important to consider CMV as a potential cause of various gastric pathologies in immunocompetent people. Further research is necessary to establish guidelines for diagnosing and treating this pathogen.
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Affiliation(s)
- Zunaira Jalil
- Department of Internal Medicine, Dr. Ruth K. M. Pfau, Civil Hospital Karachi, Karachi, Pakistan
| | - Zubia Zaman
- Department of Internal Medicine, Dr. Ruth K. M. Pfau, Civil Hospital Karachi, Karachi, Pakistan
| | - Sundarta Lund
- Department of Internal Medicine, Dr. Ruth K. M. Pfau, Civil Hospital Karachi, Karachi, Pakistan
| | - Naresh Kumar Seetlani
- Department of Internal Medicine, Dr. Ruth K. M. Pfau, Civil Hospital Karachi, Karachi, Pakistan
| | - Sidra Arshad
- Department of Pathology, Aga Khan University Hospital, Karachi, Pakistan
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2
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Jo H, Shin CM. [Infectious Gastric Diseases Other than Helicobacter]. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2023; 82:269-281. [PMID: 38129996 DOI: 10.4166/kjg.2023.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/10/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Abstract
In addition to Helicobacter pylori, the acute bacterial causes of infectious gastritis, include phlegmonous gastritis, gastric tuberculosis, and gastric syphilis. Bacterial gastritis often improves with appropriate broad-spectrum antibiotics, emphasizing the need for prompt diagnosis and treatment based on the clinical and endoscopic findings. Among viral gastritis, cytomegalovirus gastritis, primarily occurring in immunocompromised patients, necessitates antiviral intervention, while immunocompetent individuals typically achieve amelioration by administering proton pump inhibitors. In contrast, most gastric infections caused by the Epstein-Barr virus (EBV) are asymptomatic, but an EBV infection is a cause of stomach cancer. EBV-associated gastric cancer exhibits distinct clinical, pathological, genetic, and post-genetic mutation features, making it clinically significant. The colonization of Candida albicans in the stomach is uncommon, and typical antifungal treatment is unnecessary. Candida infections in gastric ulcers can be treated with anti-ulcer treatment alone. Lastly, anisakidosis in the stomach, which occurs when consuming raw seafood, can manifest in various clinical presentations and is typically treated through endoscopic removal of the nematode. This article aims to contribute to the rapid diagnosis and treatment of rare stomach infections beyond Helicobacter pylori in real clinical situations.
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Affiliation(s)
- Hyemin Jo
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Cheol Min Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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3
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Solito S, Vadalá di Prampero SF, Bulajic M, Battista S, Tomassini G, Panic N, Jankovic K, Marino M. Cytomegalovirus-Related Gastritis in an Immunocompetent Host Presenting With Infectious Gastroparesis. ACG Case Rep J 2023; 10:e01231. [PMID: 38107606 PMCID: PMC10723881 DOI: 10.14309/crj.0000000000001231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/14/2023] [Indexed: 12/19/2023] Open
Abstract
Cytomegalovirus (CMV) infection is usually asymptomatic or causes a mild mononucleosis-like syndrome, whereas severe symptoms are rarely reported. We report a case of a 70-year-old woman who was admitted to our center because of severe clinical presentation with anorexia, epigastric pain, nausea, postprandial vomiting, and significant weight loss. Esophagogastroduodenoscopy with biopsies showed ulcerative chronic gastritis with scattered large cells with inclusion bodies. Immunohistochemistry and polymerase chain reaction for CMV-DNA resulted positive. A gastric emptying of solid scintigraphy showed severe gastroparesis. The patient was discharged after 2 months of antiviral therapy completely asymptomatic. To the best of our knowledge, this is the first case of CMV-related gastroparesis in an immunocompetent patient, successfully treated with antiviral therapy.
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Affiliation(s)
- Sonia Solito
- Gastroenterology and GI Endoscopy Unit, Academic Medical Center of Udine, Udine, Italy
| | - Salvatore Francesco Vadalá di Prampero
- Gastroenterology and GI Endoscopy Unit, Mater Olbia Hospital, Qatar Foundation Endowment & Gemelli Foundation, Olbia, Italy
- Department for Digestive Endoscopy, Ospedale Isola Tiberina - Gemelli Isola, Rome, Italy
| | - Milutin Bulajic
- Gastroenterology and GI Endoscopy Unit, Mater Olbia Hospital, Qatar Foundation Endowment & Gemelli Foundation, Olbia, Italy
- Department for Digestive Endoscopy, Ospedale Isola Tiberina - Gemelli Isola, Rome, Italy
| | - Serena Battista
- Department of Pathology, Academic Medical Center of Udine, Udine, Italy
| | - Giulia Tomassini
- Gastroenterology and GI Endoscopy Unit, Mater Olbia Hospital, Qatar Foundation Endowment & Gemelli Foundation, Olbia, Italy
| | - Nikola Panic
- GI Endoscopy Unit, University Clinic "Dr Dragisa Misovic - Dedinje", Belgrade, Serbia
| | - Katarina Jankovic
- Clinic for Gastroenterohepatology, University Clinical Centre of Belgrade, Belgrade, Serbia
| | - Marco Marino
- Gastroenterology and GI Endoscopy Unit, Academic Medical Center of Udine, Udine, Italy
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Kreidieh M, Gurala D, Amarnath S, Philipose J, Colef R, Yassine AA, Gumaste V. The Unmasking of Cytomegalovirus as an Accomplice to Helicobacter pylori-Induced Severe Acute Gastroenteritis in a Healthy Host. ACG Case Rep J 2023; 10:e01181. [PMID: 37899956 PMCID: PMC10602490 DOI: 10.14309/crj.0000000000001181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 09/19/2023] [Indexed: 10/31/2023] Open
Abstract
Cytomegalovirus (CMV) belongs to the Herpesviridae family, and it is considered the largest virus to infect humans. Primary CMV infection frequently targets immunodeficient patients and is often symptomatic. However, it may remain latent or clinically unapparent for years in immunocompetent individuals. CMV infection rarely presents as an invasive disease in the latter group of individuals, in which case, the most common site of involvement in the gastrointestinal tract. When CMV affects the gastrointestinal tract, the colon and stomach are the 2 frequently involved sites. This case report describes a unique case of an immunocompetent patient who presented with acute excruciating periumbilical pain and was diagnosed with acute gastritis secondary to CMV infection and possible Helicobacter pylori-associated chronic active gastritis. Symptoms resolved entirely soon after treatment with antimicrobials that cover for both infections. The diagnosis was based on histopathologic findings from biopsies taken from the stomach during the endoscopic evaluation combined with positive CMV serology and positive CMV-deoxyribonucleic acid.
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Affiliation(s)
- Malek Kreidieh
- Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY
| | - Dhineshreddy Gurala
- Division of Gastroenterology, Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY
| | - Shivantha Amarnath
- Division of Gastroenterology, Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY
| | - Jobin Philipose
- Division of Gastroenterology, Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY
| | - Robert Colef
- Department of Pathology, Staten Island University Hospital, Northwell Health, Staten Island, NY
| | - Ahmad Abou Yassine
- Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY
| | - Vivek Gumaste
- Division of Gastroenterology, Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY
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CMV-Related Gastric Ulcer and Gastroduodenitis in an Immunocompetent Patient: A Case Report and Literature Review. Case Rep Gastrointest Med 2021; 2021:3513223. [PMID: 34804617 PMCID: PMC8604585 DOI: 10.1155/2021/3513223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background Cytomegalovirus (CMV)- related gastroduodenal infection is rare in immunocompetent hosts, and although it is considered a self-limiting condition in most cases, there is scarce literature to assert its management. Case Presentation. We report a case of a 66-year-old immunocompetent male patient diagnosed with a giant gastric ulcer caused by CMV infection. The ulcer manifested as refractory vomiting and melena. Rapid and full resolution was observed on proton-pump inhibitor (PPI) monotherapy. Conclusion Gastric CMV infection might mimic an advanced gastric tumor in individuals with an intact immune system. The condition is rare, and the diagnosis is challenging and oftentimes overlooked. However, a rapid resolution has been documented in all cases, even without antiviral therapy.
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Yeh PJ, Chiu CT, Lai MW, Wu RC, Kuo CJ, Hsu JT, Su MY, Le PH. Cytomegalovirus gastritis: Clinicopathological profile. Dig Liver Dis 2021; 53:722-728. [PMID: 33441265 DOI: 10.1016/j.dld.2020.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/02/2020] [Accepted: 12/08/2020] [Indexed: 12/11/2022]
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 2000 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.
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Affiliation(s)
- Pai-Jui Yeh
- Department of Pediatric Gastroenterology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Cheng-Tang Chiu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch5, Fu-Hsin Street, Guei-Shan District, Taoyuan City, Taoyuan, Taiwan; Taiwan Association of the Study of Small Intestinal Disease, Taiwan
| | - Ming-Wei Lai
- Department of Pediatric Gastroenterology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan; Taiwan Association of the Study of Small Intestinal Disease, Taiwan; Liver Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taiwan
| | - Ren-Chin Wu
- Department of Pathology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Chia-Jung Kuo
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch5, Fu-Hsin Street, Guei-Shan District, Taoyuan City, Taoyuan, Taiwan; Taiwan Association of the Study of Small Intestinal Disease, Taiwan
| | - Jun-Te Hsu
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Ming-Yao Su
- Taiwan Association of the Study of Small Intestinal Disease, Taiwan; Department of Gastroenterology and Hepatology, New Taipei City Municipal Tucheng Hospital (Chang Gung Memorial Hospital), Tucheng branch, Taiwan
| | - Puo-Hsien Le
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou Branch5, Fu-Hsin Street, Guei-Shan District, Taoyuan City, Taoyuan, Taiwan; Taiwan Association of the Study of Small Intestinal Disease, Taiwan; Liver Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taiwan.
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Mahajan N, Sharma A, Nasa M, Lipi L, Sharma R, Arora N, Singh B. CMV Disease of Upper GI Tract in Immunocompetent Host: Two Case Reports and Brief Review of Literature. JOURNAL OF DIGESTIVE ENDOSCOPY 2020. [DOI: 10.1055/s-0040-1716449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
AbstractGastrointestinal cytomegalovirus (GI-CMV) infection is well-reported in immunocompromised individuals and those on chemotherapy or other immunosuppressive medications. Rarely, CMV infection of gastrointestinal tract (GIT) occurs in immunocompetent individuals. Colon is the most common site of GI involvement with CMV. However, in immunocompetent individuals, upper GIT involvement is more common. Clinical spectrum of GI-CMV disease is variable and depends on the location and severity of the disease. Prompt diagnosis and treatment aids in reducing morbidity and mortality related to CMV involvement in GI tract. We present two interesting cases of CMV-induced GI ulcers in immunocompetent individuals with brief review of diagnostic and treatment challenges associated with CMV disease in immunocompetent individuals.
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Affiliation(s)
- Nikhil Mahajan
- Department of Gastroenterology, Shrimann Hospital, Jalandhar, Punjab, India
- Department of Gastroenterology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Aproo Sharma
- Department of Pathology, AFCME, New Delhi, India
| | - Mukesh Nasa
- Department of Gastroenterology, Shrimann Hospital, Jalandhar, Punjab, India
| | - Lipika Lipi
- Department of Gastro-Pathology, Medanta-The Medicity, Gurugram, Haryana, India
| | - Rini Sharma
- Department of Pathology, ASCOMS, Jammu, J & K, India
| | - Navleen Arora
- Department of Pathology, Shrimann Hospital, Jalandhar, Punjab, India
| | - Balwinder Singh
- Department of Gastroenterology, Shrimann Hospital, Jalandhar, Punjab, India
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Chen D, Zhao R, Cao W, Zhou W, Jiang Y, Zhang S, Chen Y, Fei G, Li J, Qian J. Clinical characteristics of cytomegalovirus gastritis: A retrospective study from a tertiary medical center. Medicine (Baltimore) 2020; 99:e18927. [PMID: 32000406 PMCID: PMC7004595 DOI: 10.1097/md.0000000000018927] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Cytomegalovirus (CMV) gastritis is a rare opportunistic infection with diverse clinical manifestations. Our study aimed to investigate the clinical features of Chinese patients with CMV gastritis.Six inpatients diagnosed with CMV gastritis were retrospectively enrolled, based on the finding of inclusion bodies in routine hematoxylin and eosin staining or positive anti-CMV monoclonal antibodies under immunohistochemistry in the gastric biopsy. Data, including demographics, diagnostic measurements, and medications, were collected.Abdominal pain was the most frequently reported symptom, occurring in 4 patients. Five patients were immunocompromised with associated underlying diseases, and 3 patients had decreased leukocyte differentiation antigen 4 positive (CD4) T lymphocyte counts. Only 3 patients had either positive cytomegalovirus (CMV)-immunoglobulin (Ig) M or increased copies of CMV-DNA peripherally. All patients had gastric lesions in the antrum of the stomach, including ulcers or erosions observed by gastroscopy. All patients received ganciclovir by intravenous injection (IV) as the first line anti-CMV therapy, and attained complete (4) or partial remission (2) during the follow-up.CMV gastritis should be taken into consideration in patients with immunocompromised status who have abdominal pain, nausea, or vomiting. Gastroscopy and necessary biopsy are the major diagnostic methods for CMV gastritis. Early diagnosis leads to a better prognosis for these patients.
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Affiliation(s)
| | | | - Wei Cao
- Department of Infectious Diseases
| | | | | | - Shangzhu Zhang
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | | - Ji Li
- Department of Gastroenterology
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9
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Reshetnyak TM, Doroshkevich IA, Seredavkina NV, Nasonov EL, Maev IV, Reshetnyak VI. The Contribution of Drugs and Helicobacter pylori to Gastric Mucosa Changes in Patients with Systemic Lupus Erythematosus and Antiphospholipid Syndrome. Int J Rheumatol 2019; 2019:9698086. [PMID: 31191660 PMCID: PMC6525898 DOI: 10.1155/2019/9698086] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 02/01/2019] [Accepted: 04/15/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The nature and rate of gastric mucosal (GM) damage in systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) remain to be among the unsolved problems. OBJECTIVE To define the role of H. pylori and drugs in the development of GM damages in SLE and APS. METHODS A study was conducted on 85 patients with SLE and APS. All the patients underwent esophagogastroduodenoscopy with targeted biopsy of the mucosa of the gastric body and antrum. The presence of H. pylori in the gastric biopsy specimens was determined using polymerase chain reaction. RESULTS Endoscopic examination revealed that the patients with SLE and APS on admission had the following GM changes: antral gastritis (82.4%), erosions (24.7%), hemorrhages (8.2%), and pangastritis (8.2%). SLE and APS patients showed no direct correlation between the found GM damages and the presence of H. pylori. The use of glucocorticoid, low-dose acetylsalicylic acid, nonsteroidal anti-inflammatory drug, and anticoagulant in SLE and APS patients is accompanied by GM damage. CONCLUSION There was no evidence of the role of H. pylori in GM damage in the SLE and APS patients. More frequent detection of H. pylori was observed in anticoagulants or low-dose acetylsalicylic acid users than in glucocorticoids and nonsteroidal anti-inflammatory drugs ones.
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Affiliation(s)
- Tatiana M. Reshetnyak
- 1Department of Vascular Rheumatology, VA Nasonova Research Institute of Rheumatology, Kashirskoe shosse, 34A, 115522, Moscow, Russia
- 2Department of Rheumatology, Russian Medical Academy of Postgraduate Education, Barrikadnaya str., 2/1, 125993, Moscow, Russia
| | - Irina A. Doroshkevich
- 3Municipal Outpatient Clinic No 36, Moscow Department of Health, Novomar'inskaya str., 2, 109652, Moscow, Russia
| | - Natalia V. Seredavkina
- 1Department of Vascular Rheumatology, VA Nasonova Research Institute of Rheumatology, Kashirskoe shosse, 34A, 115522, Moscow, Russia
| | - Evgeny L. Nasonov
- 4Department of Systemic Connective Tissue Diseases, VA Nasonova Research Institute of Rheumatology, Kashirskoe shosse, 34A, 115522, Moscow, Russia
| | - Igor V. Maev
- 5Department of Propaedeutic of Internal Diseases and Gastroenterology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Delegatskaya St., 20, p. 1, 127473, Moscow, Russia
| | - Vasiliy I. Reshetnyak
- 5Department of Propaedeutic of Internal Diseases and Gastroenterology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Delegatskaya St., 20, p. 1, 127473, Moscow, Russia
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Yamamoto S, Sakai Y. Acute gastritis caused by concurrent infection with Epstein-Barr virus and cytomegalovirus in an immunocompetent adult. Clin J Gastroenterol 2018; 12:274-278. [PMID: 30446952 DOI: 10.1007/s12328-018-0924-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 11/12/2018] [Indexed: 12/12/2022]
Abstract
Herein, we describe an extremely rare case of gastritis due to concurrent infection with Epstein-Barr virus (EBV) and cytomegalovirus (CMV) occurring in an immunocompetent adult. The patient was a 35-year-old man who presented with slight fever, nausea, anorexia, weight loss for 3 weeks, mild transaminitis, and leukocytosis with atypical lymphocytes in peripheral blood. The clinical presentation and elevated IgM titers to both EBV-VCA and CMV strongly suggested infectious mononucleosis syndrome caused by co-infection with EBV and CMV. A computed tomographic scan of the abdomen showed diffuse thickening of the gastric wall mimicking linitis plastica, and upper endoscopy revealed thickened and eroded mucosa throughout the stomach. Histologic examination of gastric biopsies showed a dense lymphoid and neutrophilic infiltrate in the lamina propria with erosion. In situ hybridization assay revealed many lymphocytes positive for EBV-encoded RNA. Moreover, immunohistochemistry using an anti-CMV monoclonal antibody identified some CMV-positive cells (i.e. foveolar epithelium and endothelium). We finally diagnosed this case as gastric involvement in infectious mononucleosis, and the patient recovered without the administration of antiviral drugs. To our knowledge, this is the first reported case of gastritis co-infected with EBV and CMV, as a manifestation of infectious mononucleosis in an immunocompetent adult.
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Affiliation(s)
- Sohei Yamamoto
- Department of Diagnostic Pathology, Anjo Kosei Hospital, 28 Higashi-hirokute, Anjo-cho, Anjo, Aichi, 446-8602, Japan.
| | - Yu Sakai
- Department of Diagnostic Pathology, Anjo Kosei Hospital, 28 Higashi-hirokute, Anjo-cho, Anjo, Aichi, 446-8602, Japan
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11
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Ueha R, Nito T, Goto T, Sato T, Ushiku T, Yamasoba T. Bilateral vocal cord immobility resulting from cytomegalovirus pharyngitis: A case report. J Infect Chemother 2017; 24:142-146. [PMID: 29054457 DOI: 10.1016/j.jiac.2017.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 09/07/2017] [Accepted: 09/15/2017] [Indexed: 10/18/2022]
Abstract
Human cytomegalovirus (CMV) is an infectious herpes virus present in approximately 50% of the world's population. Pharyngitis is an uncommon manifestation of CMV infection, and vocal cord immobility (VCI) following CMV pharyngitis is quite rare. An 83-year-old man with well-controlled diabetes mellitus and hypertension was admitted due to dyspnea, odynophagia, and dysphagia. Laryngeal fiberscopy revealed bilateral vocal cords almost fixed at the median position, with mucosal redness, swelling, and edema at the hypopharyngeal area. The airway was so narrowed that an emergency tracheostomy was performed to secure an airway. VCI resulting from a malignant tumor was suspected at first, but repeated pathological examinations revealed CMV infection in the pharyngeal mucosa. Despite intravenous ganciclovir treatment (5 mg/kg), the patient's bilateral VCI improved only slightly. Laryngeal electromyography was used to investigate the causes of VCI, and revealed vocal fold paralysis on the left side and cricoarytenoid joint fixation on the right side. This case highlights the importance of considering CMV infection in the differential diagnosis of patients with pharyngitis and VCI. To the best of our knowledge, this is the first case report describing the etiology of VCI following CMV pharyngitis using laryngeal electromyography.
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Affiliation(s)
- Rumi Ueha
- Department of Otolaryngology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan.
| | - Takaharu Nito
- Department of Otolaryngology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Takao Goto
- Department of Otolaryngology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Taku Sato
- Department of Otolaryngology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
| | - Tetsuo Ushiku
- Department of Pathology and Diagnostic Pathology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655 Japan
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Wong YJ, Tan BH, Leow WQ, Mesenas SJ. Cytomegalovirus infection masquerading as gastric carcinoma in an immune-compromised host. PROCEEDINGS OF SINGAPORE HEALTHCARE 2017. [DOI: 10.1177/2010105817731797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A 63-year-old man post-renal transplantation on immunosuppressants presented with reflux symptoms for one month. Significant medical history included a history of upper gastrointestinal bleeding, insulin-dependent diabetes mellitus and ischemic heart disease. Barium meal showed a large plaque-like lesion along greater curvature suspicious of malignancy. Gastroscopy revealed a large polyploidal gastric mass which was biopsied. Histological result showed numerous cytomegalovirus (CMV) viral inclusions within hyperplastic gastric mucosa without dysplasia or neoplasm. The findings were consistent with CMV gastric polyp. Following treatment with antiviral therapy and reduction in immunosuppressants, the CMV gastric polyp became smaller. This highlights the importance of considering CMV as a differential of gastric mass in an immunosuppressed host as treatment options varied between surgery and antiviral therapy.
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Affiliation(s)
- Yu Jun Wong
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
| | - Ban Hock Tan
- Department of Infectious Disease, Singapore General Hospital, Singapore
| | - Wei Qiang Leow
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - Steven Joseph Mesenas
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore
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Abstract
This article reports the case of a 45-year-old male immunocompetent patient who presented with acute epigastric pain and vomiting. Diagnostic tests confirmed a recent cytomegalovirus (CMV) infection as a contributory cause of a florid gastric ulcer. Primary CMV infections affecting the upper gastrointestinal tract are rare in immunocompetent adults. In this case treatment with a proton pump inhibitor and eradication of concomitant Helicobacter pylori colonization led to a full recovery. Anti-CMV treatment was not necessary.
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14
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Nakashima K, Aoshima M, Suzuki F, Watanabe J, Otsuka Y. Cytomegalovirus Colitis in a Critically Ill Patient Following Severe Legionella Pneumonia with Multiple Organ Failure. Intern Med 2016; 55:527-31. [PMID: 26935377 DOI: 10.2169/internalmedicine.55.4857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 68-year-old man visited an emergency department complaining of dyspnea. He was diagnosed to have Legionella pneumonia with multiple organ failure. Although his multiple organ failure improved, he suffered from persistent abdominal pain and diarrhea with continuous minor bleeding. Colonoscopy revealed a longitudinal ulcer of the rectum, below the peritoneal reflection. He was diagnosed with cytomegalovirus (CMV) colitis. Antiviral therapy with ganciclovir was initiated. He finally underwent a colostomy after a bowel stricture caused an intestinal outlet obstruction, which made oral intake impossible. Based on the present case, we believe that CMV colitis must be considered as one of the differential diagnoses when critically ill patients develop continuous diarrhea and abdominal pain.
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Affiliation(s)
- Kei Nakashima
- Department of Pulmonary Medicine, Kameda Medical Center, Japan
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Reggiani Bonetti L, Barresi V, Bertani A, Maccio L, Palmiere C. Human cytomegalovirus induced pseudotumor of upper gastrointestinal tract mucosa: Effects of long-term chronic disease? J Med Virol 2015; 87:1041-5. [DOI: 10.1002/jmv.24152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2015] [Indexed: 11/07/2022]
Affiliation(s)
| | | | - Angela Bertani
- Department of Gastroenterology; University of Modena; Italy
| | - Livia Maccio
- Division of Pathology; University of Modena; Italy
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Kwon MH, Lee CS, Cho SW, Joung CI. Multiple Gastric Ulcers as a Manifestation of Cytomegalovirus Infection in a Patient with Adult-onset Still's Disease. JOURNAL OF RHEUMATIC DISEASES 2013. [DOI: 10.4078/jrd.2013.20.3.172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Mi-Hye Kwon
- Department of Internal Medicine, Konyang University Hospital, Daejeon, Korea
| | - Choong-Seup Lee
- Department of Internal Medicine, Konyang University Hospital, Daejeon, Korea
| | - Sung-Woo Cho
- Department of Internal Medicine, Konyang University Hospital, Daejeon, Korea
| | - Chung-Il Joung
- Department of Internal Medicine, Konyang University Hospital, Daejeon, Korea
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Protein-Loosing Entropathy Induced by Unique Combination of CMV and HP in an Immunocompetent Patient. Case Rep Med 2012. [PMID: 23197985 PMCID: PMC3502835 DOI: 10.1155/2012/361892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Protein-losing gastroenteropathies are characterized by an excessive loss of serum proteins into the gastrointestinal tract, resulting in hypoproteinemia (detected as hypoalbuminemia), edema, and, in some cases, pleural and pericardial effusions. Protein-losing gastroenteropathies can be caused by a diverse group of disorders and should be suspected in a patient with hypoproteinemia in whom other causes, such as malnutrition, proteinuria, and impaired liver protein synthesis, have been excluded. In this paper, we present a case of protein-losing enteropathy in a 22-year-old immunocompetent male with a coinfection of CMV and Hp.
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Ebisutani C, Kawamura A, Shibata N, Nasu M, Ueno R, Mimura K, Kinoshita Y. Gastric ulcer associated with cytomegalovirus in an immunocompetent patient: method for diagnosis. Case Rep Gastroenterol 2012; 6:365-8. [PMID: 22740812 PMCID: PMC3383304 DOI: 10.1159/000339714] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cytomegalovirus (CMV)-associated gastric ulcers can be found not only in immunocompromised hosts but also in normal individuals. The accurate endoscopic diagnosis of CMV ulcers is not easy because of the absence of characteristic morphological features. We present a case of CMV-associated gastric ulcer in an immunocompetent patient. He was a 33-year-old male with epigastralgia. Upper gastrointestinal endoscopy showed multiple erupted papules and a large irregularly shaped shallow ulcer. We did not find intracellular inclusion bodies characteristic of CMV in hematoxylin-eosin-stained gastric biopsy specimens, while CMV antigens corresponding to intracellular inclusion bodies were confirmed using an immunoperoxidase method with the monoclonal CMV antibody. If CMV ulcers are suspected, it is important to examine for inclusion bodies using not only hematoxylin-eosin staining, but also CMV immunohistochemistry for a sensitive diagnosis.
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Affiliation(s)
- Chikara Ebisutani
- Departments of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
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Reggiani Bonetti L, Losi L, Di Gregorio C, Bertani A, Merighi A, Bettelli S, Scuri M, Maiorana A. Cytomegalovirus infection of the upper gastrointestinal tract: a clinical and pathological study of 30 cases. Scand J Gastroenterol 2011; 46:1228-35. [PMID: 21692711 DOI: 10.3109/00365521.2011.594083] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The study reviews the endoscopic and histological features of human cytomegalovirus (HCMV) infections of the upper gastrointestinal (UGI) tract. MATERIALS AND METHODS Clinical histories, endoscopic findings and bioptic specimens of 30 cases of HCMV infection of the UGI tract, diagnosed in a University Hospital in a 10-year period, were reviewed. In all cases, viral inclusion bodies were detected in routine histopathological sections and the diagnosis was confirmed with immunohistochemistry. RESULTS Six patients were HIV+, whereas four had received organ transplantations, one was affected by common variable immunodeficiency and four had a recent history of malignancy. No other pathologic condition was evidenced in the remaining 15 cases. Mucosal alterations were endoscopically observed in the stomach (19 cases), esophagus (9), cardias (6) and duodenum (1), and multiple organs being synchronously affected in five patients (3 HIV+, 2 with history of malignancy). The antropyloric area was the most frequently affected site. Single ulcers were detected in 11 cases and multiple ulcers in 8, whereas mucosal thickenings (in the form of localized thickenings, polyps or rugal hypertrophy) were present in 13 patients. Thickenings of the mucosa were detected only in the stomach. At histology, necrotic material and granulation tissue were associated with moderate or marked lympho-plasmacytic infiltrate and foveolar hyperplasia in ulcerative lesions, whereas lesions labeled as mucosal thickenings showed mild or moderate chronic inflammatory infiltrate and foveolar hyperplasia. CONCLUSIONS Endoscopic manifestations of UGI tract involvement in HCMV infection are not specific, varying from erythematous mucosa to ulcers to mucosal thickenings.
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Affiliation(s)
- Luca Reggiani Bonetti
- Section of Pathologic Anatomy, Azienda Ospedaliera-Universitaria, Policlinico, Modena, Italy.
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Matsui Y, Sugino N, Kaneko H, Watanabe M, Miura Y, Tsudo M. CMV quantitative PCR in the diagnosis of CMV-associated AGML in an immunocompetent host. Intern Med 2010; 49:1265-7; author reply 1269. [PMID: 20558964 DOI: 10.2169/internalmedicine.49.3462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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