title: Cytomegalovirus-associated gastric ulcer: a diagnostic challenge in a patient of fulminant hepatitis with steroid pulse therapy.
abstract: A 69-year-old woman presented with malaise. She had had organising pneumonia with the treatment of prednisolone. A diagnosis of fulminant hepatitis was made and steroid pulse therapy was initiated. Ten days later, a colonic resection with a colostomy was performed because of the perforated diverticulitis of the sigmoid colon. She presented with epigastric pain and melena after surgery. Despite the administration of the proton pump inhibitor, an endoscopy revealed multiple deep, punched-out ulcers of the stomach. Biopsy specimen showed cytomegalovirus (CMV) infection. The melena and CMV antigenemia was improved with ganciclovir; however the patient died from worsening of hepatic failure. We emphasise that CMV-associated gastric ulcers should be considered in the differential diagnosis of gastric ulcers in patients treated with immunosuppressive drugs.
authors.affiliation: Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan. jtamura0806@gmail.com
authors.forename: Jiro
authors.initials: J
authors.lastname: Tamura
authors.forename: Shingo
authors.initials: S
authors.lastname: Arakaki
authors.forename: Daisuke
authors.initials: D
authors.lastname: Shibata
authors.forename: Tatsuji
authors.initials: T
authors.lastname: Maeshiro
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D018549:Cryptogenic Organizing Pneumonia / Q000188:drug therapy; D003586:Cytomegalovirus Infections / Q000150:complications / Q000175:diagnosis; D017809:Fatal Outcome; D005260:Female; D019693:Hepatitis, Autoimmune / Q000150:complications / Q000188:drug therapy; D006801:Humans; D017114:Liver Failure, Acute / Q000150:complications / Q000188:drug therapy; D008775:Methylprednisolone / Q000627:therapeutic use; D013276:Stomach Ulcer / Q000150:complications / Q000175:diagnosis
chemical_list: D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone