Cytomegalovirus infection of the upper gastrointestinal tract: a clinical and pathological study of 30 cases

Abstract

Objective. The study reviews the endoscopic and histological features of human cytomegalovirus (HCMV) infections of the upper gastrointestinal (UGI) tract. Materials and methods. Clinical histories, endoscopic findings and bioptic specimens of 30 cases of HCMV infection of the UGI tract, diagnosed in a University Hospital in a 10-year period, were reviewed. In all cases, viral inclusion bodies were detected in routine histopathological sections and the diagnosis was confirmed with immunohistochemistry. Results. Six patients were HIV+, whereas four had received organ transplantations, one was affected by common variable immunodeficiency and four had a recent history of malignancy. No other pathologic condition was evidenced in the remaining 15 cases. Mucosal alterations were endoscopically observed in the stomach (19 cases), esophagus (9), cardias (6) and duodenum (1), and multiple organs being synchronously affected in five patients (3 HIV+, 2 with history of malignancy). The antropyloric area was the most frequently affected site. Single ulcers were detected in 11 cases and multiple ulcers in 8, whereas mucosal thickenings (in the form of localized thickenings, polyps or rugal hypertrophy) were present in 13 patients. Thickenings of the mucosa were detected only in the stomach. At histology, necrotic material and granulation tissue were associated with moderate or marked lympho-plasmacytic infiltrate and foveolar hyperplasia in ulcerative lesions, whereas lesions labeled as mucosal thickenings showed mild or moderate chronic inflammatory infiltrate and foveolar hyperplasia. Conclusions. Endoscopic manifestations of UGI tract involvement in HCMV infection are not specific, varying from erythematous mucosa to ulcers to mucosal thickenings.

Key Words::

• Cytomegalovirus
• esophagus
• stomach
• ulcer

Acknowledgements

The authors thank the technical staff of the Laboratory of Anatomia Patologica of Modena where the study took place. A special mention to Dr. Luca Fabbiani and Dr. Mazzei Francesca for the histological photographs. Preliminary results of this work were presented at the Annual Meeting of Italian Pathologists (SIAPEC; Bologna, 2010).

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.