3240 Cytomegalovirus Gastritis in an Immunocompetent Patient

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INTRODUCTION: Cytomegalovirus (CMV) is a large enveloped virus of the Herpes virus family. CMV frequently infects humans and can establish latent infection after an acute infection. In immune-compromised patients, CMV can have neurological, cutaneous, gastrointestinal (GI), cardiac or ocular manifestations and can cause severe organ dysfunction leading to significant morbidity and mortality. The colon and the stomach are the common sites of GI infection. CASE DESCRIPTION/METHODS: 54 year old female with no prior medical history presented to the hospital with complaints of shortness of breath for the last 3 days and was noted to be in rapid atrial fibrillation. Patient was admitted and subsequently found to have severe mitral valve stenosis and moderate to severe tricuspid regurgitation. The patient was seen by Cardio-thoracic surgery and underwent mitral valve replacement and tricuspid ring annuloplasty. During the post-operative period, the patient was found to have blood in her stool and was evaluated by the gastroenterology service. In evaluating her GI bleed, she underwent an upper endoscopy. Findings on upper endoscopy included, small hiatus hernia and a single small ulcer in the incisura of the stomach. An area of gastritis was found in the antrum/body of the stomach. The mucosa appeared nodular and edematous. Biopsies were taken from the antrum and showed gastric antral type mucosa with reactive gastropathy. CMV viral inclusions were present in the gastric pit epithelial cells, confirmed on immunostain for CMV. HIV and quantiferon gold tests were negative and the patient was not known to be on any immunosuppressive therapies. Serum CMV DNA PCR was tested on 2 subsequent days which showed 4858 IU/ml and 5548 IU/mL respectively. DISCUSSION: CMV infection of the GI tract is a common manifestation of CMV disease in the immunocompromised patients such as Acquired immunodeficiency syndrome, organ/ bone marrow transplantation and other condition requiring chronic immunosuppressive therapy. CMV of the GI tract is rare in an immunocompetent patient and only few cases have been reported so far. Presenting symptoms include odynophagia/dysphagia, epigastric pain, nausea/vomiting, GI bleeding. However, in up to 7% of cases it can be asymptomatic. Endoscopic features of CMV infection include macroscopic normal mucosa, diffuse erythema, nodules, pseudotumors, erosions and ulcers. Detection of intranuclear inclusions, also known as “owl's eye,” is the hallmark of CMV infection.