Difficulties in assessing cytomegalovirus-associated gastric perforation in an HIV-infected patient.
BACKGROUND
Active Cytomegalovirus (CMV) infection is a common complication in advanced symptomatic Human Immunodeficiency Virus (HIV) infection. CMV-induced intestinal perforations are hard to diagnose and may be observed throughout the gastrointestinal tract. Isolated stomach perforation is exceptional.


METHODS
A 47-year-old man was admitted to our intensive care unit with multiorgan failure. Gastrointestinal endoscopic examination showed erythematous gastritis but normal duodenum and colon. CMV blood culture was positive. Histologic examination of a gastric biopsy showed inflammatory infiltrate and immunostaining typical intranuclear CMV inclusion bodies. Concomitant abdominal CT scan disclosed large peripancreatic hypodensities without pneumoperitoneum. The patient died despite supportive therapies and ganciclovir infusion. Postmortem examination showed a 4-cm gastric perforation adhering to the transverse colon and liver, with a thick necrotic inflammatory coating around the pancreas. The whole GI tract, except the stomach, was normal. As other causes, especially Helicobacter pylori infection could be ruled out, a causal relationship between CMV and gastric disease was assumed.


CONCLUSIONS
CMV may be responsible for gastric perforations, with difficulties in assessing the diagnosis. Early diagnosis based on cautious endoscopy and histopathologic examination is needed to make a favorable outcome possible.
Mégarbane
Bruno
B
Medical and Toxicological Intensive Care Unit, Lariboisière Hospital, Paris, France. bruno-megarbane@wanadoo.fr
Résière
Dabor
D
Ferrand
Jacqueline
J
Raskine
Laurent
L
Vahedi
Kouroche
K
Baud
Frédéric J
FJ
D000998:Antiviral Agents / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000188:drug therapy; D017809:Fatal Outcome; D015774:Ganciclovir / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013270:Stomach / Q000473:pathology*; D013272:Stomach Diseases / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology / Q000821:virology
D000998:Antiviral Agents; D015774:Ganciclovir