Korean J Gastroenterol.  2009 Aug;54(2):117-122. 10.4166/kjg.2009.54.2.117.

Cytomegalovirus Induced Gastric Ulcer as a Principal Manifestation in the Initial Stage of Hodgkin's Disease

• Hwang ET
• Lee JY
• Chung JS
• Lee JH
• Choi CS
• Kim TH
• Choi SC

• KMID: 1775966
• DOI: http://doi.org/10.4166/kjg.2009.54.2.117

Abstract

Cytomegalovirus (CMV) is an important cause of opportunistic infection in immunocompromised patients. CMV infection occurs as a result of the cell-mediated immunity change in lymphoma patients. Although CMV can cause ulceration anywhere in the gastrointestinal (GI) tract in immunocompromised patients, only a few case reports about CMV GI infection in malignant lymphoma have been documented in literature. Furthermore, it was rare that CMV gastric ulcer with massive bleeding presented as an initial manifestation in a patient who has been not diagnosed lymphoma. We report a case of CMV induced gastric ulcer as an initial manifestation in patient with Hodgkin's disease.

Keyword

Cytomegalovirus (CMV); Hodgkin disease; Stomach ulcer

MeSH Terms

Aged
Cytomegalovirus
Cytomegalovirus Infections/*diagnosis/pathology
Diagnosis, Differential
Gastroscopy
Hodgkin Disease/complications/*diagnosis
Humans
Male
Stomach Ulcer/*diagnosis/pathology/virology
Tomography, X-Ray Computed

Figure

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  Fig. 1. Initial endoscopic finding of gastric lesion. On the cardia, large adherent dark blood clot covered ulcer with dirty base and protruding exposed vessel was seen.

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  Fig. 2. Computed tomography findings. (A) About 1 cm-sized enlarged paraaortic lymph nodes and 2-3 cm-sized large inguinal lymph nodes with mild splenomegaly were seen on initial computed tomography. (B) On the fifth month after initial study, markedly enlarged intraabdominal and inguinal lymph nodes with apparent splenomegaly were seen.

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  Fig. 3. An endoscopic finding on the tenth hospital day. Whitish exudate covered geographic shaped ulcer was seen.

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  Fig. 4. Microscopic findings of biopsy specimen obtained from base of ulcer. (A) Typical multiple cytomegalic cells with characteristic intranuclear (arrow) and intracytoplasmic (arrow head) inclusion bodies surrounded by a clear halo (“owl's eye” effect) were noted (H&E stain, ×400). (B) Immunohistochemical stain with monoclonal antibody showed positive reaction for CMV antigen.

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  Fig. 5. An endoscopic finding on the four months after discharge. Completely healed previously noted cardia ulcer was seen.

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  Fig. 6. Microscopic findings of excisional biopsy specimen obtained from right supraclavicular lymph node. (A) Reed-Sternberg cell with lymphocyte-rich background was noted (H&E stain, ×400). (B) Immunohistochemical stain for CD30 showed positive reaction.

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