A Case of Cytomegalovirus Gastritis in an Immunocompetent Patient

Abstract

Cytomegalovirus (CMV) infection of the stomach is rare even in immunocompromised patients. We report an unusual case of CMV infection presenting as gastritis in an immunocompetent patient. A 78 year old black female with history of hypertension, dyslipidemia, peripheral vascular disease and stroke, presented with history of abdominal pain, weight loss, persistent nausea and vomiting for 2 weeks. The pain was described as dull, aching and localized to the epigastric region. There was no associated fever or change in bowel habits. She denied hematemesis, hematochezia or melena. She denied any unusual food intake or travel. Pertinent medication included clopidogrel. On examination, the patient was afebrile with normal vital signs. Abdominal examination was significant for mild epigastric tenderness, active bowel sounds and no organomegaly. She underwent a workup including a CT scan of the abdomen and pelvis which showed mild thickening of the distal stomach. Subsequent EGD showed friable, erythematous and edematous antral mucosa. Biopsies of the antrum showed gastritis with viral inclusions consistent with CMV gastritis. The patient was treated with valganciclovir 450 mg PO BID. HIV testing was negative and CD4 count was 550/cu mm. She had a follow up endoscopy showing resolution of the gastritis. Repeat biopsies showed no morphological evidence of CMV infection. The patient reported resolution of her symptoms. She also had a colonoscopy to look for any CMV changes in the colon, which was not present. There are few case reports of CMV gastritis in immunocompromised patients, such as HIV infected patients, and bone marrow and solid organ transplant recipients. CMV gastritis in immunocompetent patients is a very rare event. There has been only one prior case report of an immunocompetent patient presenting with gastric ulcer as the only manifestation of CMV infection. Gastritis is an infrequent manifestation of gastrointestinal CMV in a healthy host. The clinical course in these patients is usually self limited. They may present with nonspecific symptoms such as abdominal pain, nausea and vomiting, rarely with symptoms of hemorrhagic gastritis and gastrointestinal dysmotility. Diagnosis of CMV gastritis requires morphological changes consistent with CMV infection on biopsy.