Korean J Gastroenterol.  2017 Jun;69(6):359-362. 10.4166/kjg.2017.69.6.359.

Cytomegalovirus Gastric Ulcer Complicated with Pyloric Obstruction in a Patient with Ulcerative Colitis

• Kang SH
• Lee KM
• Shin SJ
• Lim SK
• Hwang JC
• Kim JH

• KMID: 2384363
• DOI: http://doi.org/10.4166/kjg.2017.69.6.359

Abstract

In patients with inflammatory bowel disease (IBD), cytomegalovirus (CMV) infections could aggravate the course of IBD but it is difficult to distinguish CMV infection from IBD exacerbation endoscopically. Usually, CMV tends to localize to the colon and other organic involvements were reported very rare in the IBD patients. Herein, we report a case that CMV gastric ulcer complicated with pyloric obstruction in a patient with ulcerative colitis during ganciclovir therapy, which was resolved by surgical gastrojejunostomy with review of literature.

Keyword

Cytomegalovirus; Gastric ulcer; Gastric outlet obstruction; Ulcerative colitis

MeSH Terms

Colitis, Ulcerative*
Colon
Cytomegalovirus*
Ganciclovir
Gastric Bypass
Gastric Outlet Obstruction
Humans
Inflammatory Bowel Diseases
Stomach Ulcer*
Ulcer*
Ganciclovir

Figure

• 

  Fig. 1 Endoscopic findings. (A) Endoscopic finding of the gastric lesions. It shows a huge, deepencirculating ulcerative lesion on the antrum, covered with white exudate, with relatively clear margin and even base. (B) Colonoscopic finding. It shows erythematous and friable mucosa from the cecum to the rectum with multiple mucosal defects.

• 

  Fig. 2 Pathologic findings. (A) Typical crypt abscess, showing collection of PMNs in the crypts (arrow) is noted in colonic mucosa (colon, H&E, ×100). (B) Typical eosinophilic inclusion bodys are noted in the nucleus with halo (arrows) of the CMV infected cell (colon, H&E, ×400). (C) Eosinophilic inclusion body (arrow) is noted in the nucleus of the endothelial cell in the gastric mucosa (stomach, H&E, ×400). PMNs, polymorphonuclear; CMV, cytomegalovirus.

• 

  Fig. 3 Upper gastrointestinal series finding. It shows no passage of contrast-material through the pylorus and marked distention of the stomach, suggesting total obstruction at the gastric pylorus.

Reference

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