Cytomegalovirus infective gastritis in an immunocompetent host misdiagnosed as malignancy on upper gastrointestinal endoscopy: a case report and review of literature

Primary cytomegalovirus (CMV) infection is rare in immunocompetent hosts and generally asymptomatic. CMV infective gastritis in patients without immunosuppression is very unusual. A 44-year-old man presented with complaints of intermittent epigastric pain. He had no history of organ transplantation, human immunodeficiency virus infection, or immunosuppression of any type. Upper gastrointestinal endoscopy revealed ulcers in the gastric antrum and uplift of the gastric body. Computed tomography scan showed obvious thickening of the gastric wall and enlargement of retroperitoneal lymph nodes, suggesting malignancy. However, the first biopsy only showed ulcerative inflammation, necrosis, and mucosal erosions around the ulcer. Repeat biopsy and histopathological examination showed CMV inclusions in glandular endothelial cells. Immunohistochemistry findings supported the diagnosis of CMV infective gastritis. Symptoms subsided after treatment with intravenous ganciclovir, and the gastric ulceration and surrounding mucosal inflammation decreased. This case report and review of literature is presented to increase awareness regarding this rare disease. (C) 2018 Elsevier Inc. All rights reserved.