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KMID : 0931320150150010044
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대한상부위장관.헬리코박터학회지
2015 Volume.15 No. 1 p.44 ~ p.48
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A Case of Cytomegalovirus-associated Giant Gastric Ulcer in a Patient Who Healed by Discontinuing Immunosuppressive Therapy
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신준영:Shin Jun-Young
고은정:Ko Eun-Jung/방병욱:Bang Byoung-Wook/권계숙:Kwon Kye-Sook/김형길:Kim Hyung-Gil/신용운:Shin Yong-Woon/김준미:Kim Joon-Mi/기성호:Ki Sung-Ho
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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.
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KEYWORD
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Cytomegalovirus, Stomach ulcer, Steroids, Immunosuppressive agents, Dermatomyositis
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