Cytomegalovirus gastritis associated with pseudolymphoma

A man who previously had several episodes of upper gastrointestinal hemorrhage from erosive gastritis developed recurrent hemorrhage. Endoscopy showed punctate hemorrhages in the fundus and body of the stomach, plus a discrete area of thickened folds in the anterior wall. Biopsies revealed a dense mucosal infiltrate that included cytomegaloviral inclusions. Bleeding continued despite treatment with blood transfusions and ranitidine. Because of continued hemorrhage, and to distinguish the cause of the thickened folds, surgical biopsy was performed that showed lymphoid germinal formations, characteristic of pseudolymphoma. He responded to i.v. ganciclovir and has had no further bleeding during 2 years of follow-up.