The Unmasking of Cytomegalovirus as an Accomplice to Helicobacter pylori –Induced Severe Acute Gastroenteritis in a Healthy Host

ACG Case Reports Journal · 7 authors, 3 centres

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TL;DR

Symptoms resolved after treatment with antimicrobials targeting both infections.

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This is a case report of an immunocompetent adult presenting with severe epigastric pain, vomiting, and diarrhea. Histopathology revealed CMV-infected epithelial cells and chronic active gastritis. Diagnosis of primary CMV infection was confirmed by positive CMV IgM serology, negative CMV IgG, and positive serum CMV-DNA PCR, while H. pylori was not detected in biopsies. The patient was treated with intravenous ganciclovir and then oral valganciclovir for CMV, along with quadruple antibiotic therapy for possible H. pylori, leading to complete symptom resolution. The report highlights the rarity of severe primary CMV gastritis in healthy hosts, discusses diagnostic approaches, and notes that while antiviral treatment for CMV gastritis in immunocompetent patients is not standard, it was used here due to symptom severity.

STUDY TYPE

case_report

SPECIALTY

gastroenterology

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100% · A

ORIGINAL PAPER

PMC10602490

The Unmasking of Cytomegalovirus as an Accomplice to Helicobacter pylori –Induced Severe Acute Gastroenteritis in a Healthy Host

ACG Case Reports Journal

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ABSTRACT

ABSTRACT Cytomegalovirus (CMV) belongs to the Herpesviridae family, and it is considered the largest virus to infect humans. Primary CMV infection frequently targets immunodeficient patients and is often symptomatic. However, it may remain latent or clinically unapparent for years in immunocompetent individuals. CMV infection rarely presents as an invasive disease in the latter group of individuals, in which case, the most common site of involvement in the gastrointestinal tract. When CMV affects the gastrointestinal tract, the colon and stomach are the 2 frequently involved sites. This case report describes a unique case of an immunocompetent patient who presented with acute excruciating periumbilical pain and was diagnosed with acute gastritis secondary to CMV infection and possible Helicobacter pylori –associated chronic active gastritis. Symptoms resolved entirely soon after treatment with antimicrobials that cover for both infections. The diagnosis was based on histopathologic findings from biopsies taken from the stomach during the endoscopic evaluation combined with positive CMV serology and positive CMV-deoxyribonucleic acid.

CITATION EXPORT

Malek Kreidieh, Dhineshreddy Gurala, Shivantha Amarnath et al.. The Unmasking of Cytomegalovirus as an Accomplice to Helicobacter pylori–Induced Severe Acute Gastroenteritis in a Healthy Host. ACG Case Reports Journal. (2023). https://doi.org/10.14309/crj.0000000000001181

AUTHORS

7 · 3 CENTRES

Malek Kreidieh, Dhineshreddy Gurala, Shivantha Amarnath, Jobin Philipose, Robert Colef, Ahmad Abou Yassine, Vivek Gumaste

1Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY
2Division of Gastroenterology, Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY
3Department of Pathology, Staten Island University Hospital, Northwell Health, Staten Island, NY