Occult gastrointestinal bleeding as a manifestation of cytomegalovirus gastritis in an immunocompetent host

Aims A 73-year-old woman presented with a recent history of fatigue and episodic vomiting in the past 2 months. The physical exam on admission was only notable for palor of the skin and mucosas. Complete blood count (CBC) documented a severe anemia (hemoglobin 5.5 g/dL).

Methods An abdominal CT-scan reveal only adenopathies, without other relevant findings. Upper endoscopy revealed a 25 millimeter lesion with ulceration in the gastric remnant.

Results Because of the macroscopic aspect, a probable gastric neoplasia was assumed and multiple biopsies were taken. However, the histological results showed chronic inflammation with inclusion bodies compatible with CMV infection, confirmed by immunohistochemistry. Assuming a CMV gastritis, in an immunocompetent host, the patient started a regimen with proton-pump inhibitor and valganciclovir with good response and healing of the ulcer in a follow-up endoscopy [1] [2] [3] [4].

Conclusions This case reports a rare manifestation of CMV disease in an immunocompetent patient, also with an atypical presentation: occult gastrointestinal bleeding. Invasive disease is more common and severe in immunocompromised patients, such as those with HIV infection, cancer and ongoing chemotherapy, long term corticosteroid therapy and transplant recipients. Endoscopic features are ambiguous making this diagnosis difficult in the absence of high clinical suspicion. CMV gastritis in immunocompetent hosts is assumed to be a self-limiting condition in most cases.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

• 1 Beany A, Rainis T.. CMV-Related Gastric Ulcer and Gastroduodenitis in an Immunocompetent Patient: A Case Report and Literature Review. Case Rep Gastrointest Med 2021; 2021: 1-6
• 2 Crespo P, Dias N, Marques N, Da Cunha JS.. Gastritis as a manifestation of primary CMV infection in an immunocompetent host. BMJ Case Rep 2015; 2015: 2014-2016
• 3 Rafailidis PI, Mourtzoukou EG, Varbobitis IC, Falagas ME.. Severe cytomegalovirus infection in apparently immunocompetent patients: A systematic review. Virol J 2008; 5: 1-7
• 4 Chaemsupaphan T, Limsrivilai J, Thongdee C. et al. Patient characteristics, clinical manifestations, prognosis, and factors associated with gastrointestinal cytomegalovirus infection in immunocompetent patients. BMC Gastroenterol 2020; 20 (01) 1-12

Publication History

Article published online:
14 April 2023