title: Value of laboratory investigations in clinical suspicion of cytomegalovirus-induced upper gastrointestinal tract ulcerations in HIV-infected patients.
abstract: To assess the value of laboratory investigations for the diagnosis and treatment of cytomegalovirus-induced upper gastrointestinal tract ulcerations, the medical records and biopsy material from HIV-infected patients were reviewed retrospectively during a 12-month period. Clinical diagnosis of cytomegalovirus (CMV) ulceration, based on characteristic endoscopic appearance of extensive ulceration of the mid- to distal esophageal or gastric mucosa and responsiveness to anti-CMV therapy, was compared with laboratory investigations of biopsies. Laboratory procedures consisted of both histopathological examination of the biopsy specimens and viral culture. Twenty episodes in 12 HIV-infected patients could be evaluated. Clinical diagnosis of CMV ulceration appeared to be justified in 14 of 20 episodes (70%), which were confirmed by laboratory investigations. Of the remaining six episodes, which showed partial or no response to anti-CMV therapy, laboratory investigations were negative in two episodes and discrepant in four episodes (histopathology or viral culture positive). A good response to anti-CMV therapy was more frequent in patients whose biopsies proved positive by histopathological examination and/or viral culture than in patients with negative tests (82% versus 0%), which indicates the importance of both investigations. In conclusion, laboratory diagnosis of CMV-induced upper gastrointestinal tract ulcerations supported the diagnosis and decisions on treatment of CMV-induced upper gastrointestinal tract ulcerations.
authors.affiliation: Department of Clinical Virology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: J W
authors.initials: JW
authors.lastname: Dorigo-Zetsma
authors.forename: J T
authors.initials: JT
authors.lastname: van der Meer
authors.forename: M
authors.initials: M
authors.lastname: Tersmette
authors.forename: F J
authors.initials: FJ
authors.lastname: ten Kate
authors.forename: P M
authors.initials: PM
authors.lastname: Wertheim-van Dillen
authors.forename: J
authors.initials: J
authors.lastname: van der Noordaa
mesh_terms: D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000150:complications / Q000175:diagnosis*; D004935:Esophageal Diseases / Q000150:complications / Q000473:pathology / Q000821:virology*; D015658:HIV Infections / Q000150:complications* / Q000821:virology; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013276:Stomach Ulcer / Q000150:complications / Q000175:diagnosis / Q000821:virology*; D014456:Ulcer / Q000150:complications / Q000175:diagnosis / Q000821:virology*