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124

MULTIPLE LARGE GASTRIC ULCERS AS A MANIFESTATION OF CMV INFECTION IN HEALTHY CHILD

H Alanazi, L Jewel, HQ Huynh
¹Division of Pediatric Gastroenterology and Nutrition, Department of Pediatric; ²Department of Histopathology, University of Alberta, Edmonton, Alberta

Infection due to cytomegalovirus (CMV) in the gastrointestinal tract causes significant morbidity and mortality in immunocompromised individuals. CMV infection in the immunocompetent host outside the perinatal period is generally assumed to be asymptomatic. In immunocompetent children, CMV infection of the gastrointestinal tract has been reported to cause Menetrier's disease and enterocolitis in a few cases. Here we report a previously healthy 7-year-old boy who presented with a two-week history of severe abdominal pain, vomiting, hematemesis, lethargy and fever. He was admitted under pediatric surgery for possible surgical abdomen. Initial investigations: Hb 100 g/L, WBC 15.7 ´ 10⁹/L, Platelet 434 ´ 10⁹/L, albumin 29 g/L, CRP 55 mg/L, serum levels of IgA, IgG, IgM were normal, IgG subclass was normal, serum gastrin level was 84 ng/L, CMV serology IgM and IgG were positive. Subsequent gastroscopy demonstrated multiple large, flat-based gastric ulcers ranging 2 cm to 3 cm in size in antrum and the body of stomach mucosa. Immunohistochemistry, performed on the biopsies from edge of ulcers, demonstrated positive early CMV antigen. CMV was also cultured from gastric biopsy. He was treated a proton pump inhibitor and sucralfate for three months without any antiviral agent. His condition rapidly improved and was discharged after several days in hospital. He remains asymptomatic since. Repeat gastroscopy two months latter demonstrated scarring antral and body mucosa with residual erythema and mild friability in some areas. CMV culture was positive on the second repeat gastric biopsy. Gastroscopy at six months follow-up demonstrated completely healed but scarred antral and body mucosa. Culture of gastric biopsy at six months was negative for CMV.
In conclusion, CMV infection causing gastric ulcers has been reported in immunocompetent adults. As far as we could ascertain this is the first report of CMV causing gastric ulcers in an immunocompetent child. CMV should be consider as another rare cause of gastric ulcers and should be looked for in children presented with severe and persistent upper gastrointestinal symptoms. In immunocompetent children, CMV-associated gastric ulcer can be successfully treated proton pump inhibitor and sucralfate without the use of antiviral medication, such as gancyclovir.

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