title: Cytomegalovirus-associated gastric ulcer: a side effect of steroid injections for pyloric stenosis.
abstract: The local injection of triamcinolone acetonide (TA) is effective in preventing pyloric stenosis and deformity following large endoscopic submucosal dissection (ESD). However, because of its long-acting nature, TA can induce long-term local immunosuppression and subsequent adverse events. We report a case of a cytomegalovirus (CMV) ulcer that formed only at the TA local injection site. A 68-year-old man underwent ESD to treat early gastric cancer that formed over the pylorus. The lesion extended to the duodenum, and an artificial ulcer covered more than two-thirds of the circumference of the pylorus. To prevent pyloric stenosis, TA was locally injected into the ulcer floor. On day 12, a deeper ulcer 10 mm in diameter was discovered in the center of the post-ESD ulcer. Biopsies revealed large cells with intranuclear inclusion bodies, which stained positive for the anti-CMV antibody. Local TA injections are useful, however, CMV ulcer might occur as adverse events.
authors: Departments of Gastroenterology and Neurology, Kagawa Medical University School of Medicine, Kagawa 761-0793, Japan. hiro4884@med.kagawa-u.ac.jp
authors: Hirohito
authors: H
authors: Mori
authors: Shintaro
authors: S
authors: Fujihara
authors: Noriko
authors: N
authors: Nishiyama
authors: Hideki
authors: H
authors: Kobara
authors: Makoto
authors: M
authors: Oryu
authors: Kiyohito
authors: K
authors: Kato
authors: Kazi
authors: K
authors: Rafiq
authors: Tsutomu
authors: T
authors: Masaki
mesh_terms: D000368:Aged; D001706:Biopsy; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000276:immunology / Q000821:virology*; D005773:Gastroscopy; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D007267:Injections; D008297:Male; D011707:Pyloric Stenosis / Q000517:prevention & control*; D012307:Risk Factors; D013256:Steroids / Q000008:administration & dosage / Q000009:adverse effects*; D013276:Stomach Ulcer / Q000175:diagnosis / Q000276:immunology / Q000821:virology*; D013997:Time Factors; D014222:Triamcinolone Acetonide / Q000008:administration & dosage / Q000009:adverse effects*; D014945:Wound Healing
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids; D014222:Triamcinolone Acetonide
keywords: Adverse events; Cytomegalovirus-associated ulcer; Local immunosuppression; Local triamcinolone acetonide injection; Pyloric stenosis