Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Cytomegalovirus-associated esophageal ulcer in an immunocompetent infant: When should ganciclovir be administered?

  • Jang, Hyo-Jeong (Department of Pediatrics, Keimyung University School of Medicine) ;
  • Kim, Ae Suk (Department of Pediatrics, Dongguk University College of Medicine) ;
  • Hwang, Jin-Bok (Department of Pediatrics, Keimyung University School of Medicine)
  • Received : 2012.05.24
  • Accepted : 2012.08.20
  • Published : 2012.12.15
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Abstract

Cytomegalovirus (CMV)-associated esophageal ulcer is rare in immunocompetent infants. The presence of inclusion bodies and immunohistochemical staining for CMV in biopsy specimens obtained during esophagogastroduodenoscopy (EGD) indicate that such ulcers occur because of CMV infection. A 7-week-old female infant who experienced frequent vomiting and feeding intolerance was diagnosed with a massive CMV-associated ulcer in the distal esophagus. The ulcer improved after conservative treatment using proton-pump inhibitors; however, ganciclovir was not administered. In a follow-up EGD biopsy specimen, no CMV inclusion bodies were present, and immunohistochemical staining results for this virus were negative. The presence of CMV inclusion bodies indicates active viral replication. If persistent inclusion bodies or positive immunohistochemical staining for CMV is observed in follow-up biopsy specimens, ganciclovir may be used to treat CMV-associated esophageal ulcers.

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References

  1. Alanazi AH, Aldekhail WM, Jewell L, Huynh HQ. Multiple large gastric ulcers as a manifestation of cytomegalovirus infection in a healthy child. J Pediatr Gastroenterol Nutr 2009;49:364-7. https://doi.org/10.1097/MPG.0b013e31818255a9
  2. Arnar DO, Gudmundsson G, Theodors A, Valtysson G, Sigfusson A, Jonasson JG. Primary cytomegalovirus infection and gastric ulcers in normal host. Dig Dis Sci 1991;36:108-11. https://doi.org/10.1007/BF01300097
  3. Hwang JB, Park MH, Lee BY, Choi WJ, Kim CS, Lee SL, et al. Clinical quiz. Cytomegalovirus infection. J Pediatr Gastroenterol Nutr 2006; 42:607-8. https://doi.org/10.1097/01.mpg.0000164206.13669.3c
  4. Rafailidis PI, Mourtzoukou EG, Varbobitis IC, Falagas ME. Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review. Virol J 2008;5:47. https://doi.org/10.1186/1743-422X-5-47
  5. Ukarapol N, Chartapisak W, Lertprasertsuk N, Wongsawasdi L, Kattipattanapong V, Singhavejsakul J, et al. Cytomegalovirus-associated manifestations involving the digestive tract in children with human immunodeficiency virus infection. J Pediatr Gastroenterol Nutr 2002;35:669-73. https://doi.org/10.1097/00005176-200211000-00016
  6. Galiatsatos P, Shrier I, Lamoureux E, Szilagyi A. Meta-analysis of outcome of cytomegalovirus colitis in immunocompetent hosts. Dig Dis Sci 2005;50:609-16. https://doi.org/10.1007/s10620-005-2544-6
  7. Tezer H, Devrim I, Kara A, Cengiz AB, Secmeer G. Ganciclovir therapy in an immunocompetent child with resistant fever and hepatosplenomegaly due to cytomegalovirus infection. Who and when to treat? Int J Infect Dis 2008;12:340-2. https://doi.org/10.1016/j.ijid.2007.07.005
  8. Patra S, Samal SC, Chacko A, Mathan VI, Mathan MM. Cytomegalovirus infection of the human gastrointestinal tract. J Gastroenterol Hepatol 1999;14:973-6. https://doi.org/10.1046/j.1440-1746.1999.01986.x
  9. Kim SH, Kim YS, Kim HW, Yoon HE, Kim HK, Kim YO, et al. A case of cytomegalovirus colitis in an immunocompetent hemodialysis patient. Hemodial Int 2011;15:297-300. https://doi.org/10.1111/j.1542-4758.2010.00520.x

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