title: Postural epigastric pain as a sign of cytomegalovirus gastritis in renal transplant recipients: a case-based review.
abstract: BACKGROUND
  Cytomegalovirus (CMV) infection is a common cause of morbidity and mortality among patients receiving chronic maintenance immunosuppression and is often considered the most important infection in renal transplantation. CMV gastritis has been reported in transplant recipients. Symptoms are usually considered nonspecific, and gastroscopy with biopsy is usually performed to establish the diagnosis.
  
  
  METHODS
  We report a case of primary CMV gastritis in a renal transplant recipient. A 34-year-old man presented 4 months after renal transplantation with a 1-week history of epigastric pain that decreased in supine position, increased while sitting, and further increased when standing or walking. The immunosuppressive regimen consisted of tacrolimus, mycophenolate mofetil, and prednisone. Evaluation revealed CMV viremia with a high viral load and CMV gastritis was confirmed using gastroscopy and histopathologic examination. Intravenous ganciclovir was started and continued for 3 weeks. The epigastric pain completely resolved after treatment with ganciclovir.
  
  
  CONCLUSIONS
  Postural epigastric pain as a sign of CMV gastritis is fairly rare in renal transplant recipients. To our knowledge this is the third article presented in the literature so far.
authors.affiliation: Department of Urology, West China Hospital, Sichuan University, People's Republic of China.
authors.forename: W
authors.initials: W
authors.lastname: Li
authors.forename: H
authors.initials: H
authors.lastname: Fan
authors.forename: L
authors.initials: L
authors.lastname: Yiping
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000473:pathology; D004945:Esophagoscopy; D015774:Ganciclovir / Q000627:therapeutic use; D005756:Gastritis / Q000821:virology*; D005773:Gastroscopy; D005921:Glomerulonephritis / Q000601:surgery; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D010146:Pain / Q000209:etiology / Q000821:virology; D011187:Posture; D013270:Stomach / Q000473:pathology / Q000821:virology; D016896:Treatment Outcome; D014766:Viremia / Q000175:diagnosis*
chemical_list: D000914:Antibodies, Viral; D000998:Antiviral Agents; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D015774:Ganciclovir