Abstract
BackgroundActive Cytomegalovirus (CMV) infection is a common complication in advanced symptomatic Human Immunodeficiency Virus (HIV) infection. CMV-induced intestinal perforations are hard to diagnose and may be observed throughout the gastrointestinal tract. Isolated stomach perforation is exceptional.Case presentationA 47-year-old man was admitted to our intensive care unit with multiorgan failure. Gastrointestinal endoscopic examination showed erythematous gastritis but normal duodenum and colon. CMV blood culture was positive. Histologic examination of a gastric biopsy showed inflammatory infiltrate and immunostaining typical intranuclear CMV inclusion bodies. Concomitant abdominal CT scan disclosed large peripancreatic hypodensities without pneumoperitoneum. The patient died despite supportive therapies and ganciclovir infusion. Postmortem examination showed a 4-cm gastric perforation adhering to the transverse colon and liver, with a thick necrotic inflammatory coating around the pancreas. The whole GI tract, except the stomach, was normal. As other causes, especially Helicobacter pylori infection could be ruled out, a causal relationship between CMV and gastric disease was assumed.ConclusionCMV may be responsible for gastric perforations, with difficulties in assessing the diagnosis. Early diagnosis based on cautious endoscopy and histopathologic examination is needed to make a favorable outcome possible.
Highlights
Active Cytomegalovirus (CMV) infection is a common complication in advanced symptomatic Human Immunodeficiency Virus (HIV) infection
We report here the fatal case of an HIV-infected patient, who presented a CMV-associated gastric perforation
In HIV-infected patients, CMV is significantly associated with chronic active gastritis or gastroduodenal ulcers [79], in contrast with healthy adults, in whom symptomatic CMV gastric infection is exceptional [10]
Summary
Cytomegalovirus (CMV) is frequently isolated from immunosuppressed patients with HIV infection, organ or bone marrow transplants, malignancies or immunosuppressive medications. CMV may cause disseminated diseases and is generally predictive, in HIV-infected patients, of poor long-term survival reflecting severe immunosuppression [1]. We report here the fatal case of an HIV-infected patient, who presented a CMV-associated gastric perforation. Early recognition of CMV GI infection, including blood cultures and cautious GI endoscopic evaluation, may allow for adequate therapy, preventing complications, such as lifethreatening bleeding or perforation [3,11]. Concomitant abdominal CT scan showed large hypodense images surrounding the pancreas, attributed after postmortem examination, to the hemorrhagic and necrotic inflammatory materials that filled in the gastric perforation. Ganciclovir therapy successfully reduced CMV viral load before the occurrence of death, which resulted from misdiagnosed gastric perforation
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