An Unusual Case of CMV Gastritis in a Healthy Adult

Abstract

Case Report: A 24-year-old obese female presented with a 2-week history of abdominal pain, nausea, vomiting, and dark stools. Her past medical history was significant for menorrhagia and iron deficiency anemia. Her abdomen was soft, moderately tender with normal bowel sounds. Superficial lymph nodes, including cervical, axillary, and inguinal were not palpable. Lab results revealed hemoglobin of 7.8 g/dL, MCV of 75.8 fL, WBC of 5.38 k/uL with lymphocytes at 61%, and monocytes at 7%. CT of the abdomen revealed an enlarged spleen. Monospot test was negative. Screening for HSV, syphilis, parvovirus, ova, and parasites was unremarkable. Serology for HIV 1 and 2 was negative. Her CD4 count was 615 cells/uL, CD8 count was 727 cell/uL, and the CD4:CD8 ratio was 0.85. Serology for EBV was positive for IgG and IgM antibodies against viral capsid antigens and IgG antibodies against nuclear antigen and early antigen. An EGD was done, which revealed a normal esophagus, moderate gastritis with edematous gastric folds, many non-bleeding superficial gastric ulcers spread on the entire stomach, with the largest measuring 3 mm, and a normal duodenum (Figure 1). The biopsy of the lesion revealed scattered cells with characteristic CMV inclusion bodies, and immune-histochemical staining was positive for CMV and negative for H.pylori (Figures 2A, 2B). Culture of the gastric biopsy also yielded CMV. She was treated with ganciclovir and omeprazole. Follow-up 4 weeks later revealed complete resolution of her symptoms.Figure 1Figure 2Discussion: Primary CMV infection in normal hosts is aymptomatic, but can lead to a mononucleosislike syndrome and, rarely, severe organ specific complications. This case shows the occurrence of classical CMV gastritis lesions in a normal healthy and young host, and emphasizes the need to include CMV in the differential when multiple, shallow gastric ulcers are found on upper endoscopy, even in immunocompetent hosts.