| A Case of Cytomegalovirus-associated Giant Gastric Ulcer in a Patient Who Healed by Discontinuing Immunosuppressive Therapy |
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Jun Young Shin, Eun Jung Ko, Byoung Wook Bang, Kye Sook Kwon, Hyung Gil Kim, Yong Woon Shin, Jun Mee Kim, Sung Ho Ki |
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. |
| 면역억제제 중단으로 호전된 거대세포바이러스에 의해 유발된 거대위궤양 1예 |
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신준영, 고은정, 방병욱, 권계숙, 김형길, 신용운, 김준미1, 기성호2 |
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인하대학교 의과대학 내과학교실 소화기내과, 병리학교실1, 포항성모병원 내과2 |
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| Abstract |
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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. |
| Key Words:
Cytomegalovirus; Stomach ulcer; Steroids; Immunosuppressive agents; Dermatomyositis |
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