Gastric ulcer associated with cytomegalovirus in an immunocompetent patient: method for diagnosis

Cytomegalovirus (CMV)-associated gastric ulcers can be found not only in immunocompromised hosts but also in normal individuals. The accurate endoscopic diagnosis of CMV ulcers is not easy because of the absence of characteristic morphological features. We present a case of CMV-associated gastric ulcer in an immunocompetent patient. He was a 33-year-old male with epigastralgia. Upper gastrointestinal endoscopy showed multiple erupted papules and a large irregularly shaped shallow ulcer. We did not find intracellular inclusion bodies characteristic of CMV in hematoxylin-eosin-stained gastric biopsy specimens, while CMV antigens corresponding to intracellular inclusion bodies were confirmed using an immunoperoxidase method with the monoclonal CMV antibody. If CMV ulcers are suspected, it is important to examine for inclusion bodies using not only hematoxylin-eosin staining, but also CMV immunohistochemistry for a sensitive diagnosis.