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Updated: Aug 13, 2025
Dissecting Innate Immune Signaling in Viral Evasion of Cytokine Production
Published on: March 2, 2014
[Cytomegalovirus reactivation in patients with immune-mediated gastritis]
Diana Paredes-Ruiz1, Flora López-López2, Juan Antonio Núñez-Sobrino2
1Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, España.
Insights
Cytomegalovirus (CMV) reactivation can worsen gastritis in patients treated with immune checkpoint inhibitors. Early identification and ganciclovir treatment improve outcomes for severe cases.
Area of Science:
- Oncology
- Immunology
- Infectious Diseases
Background:
- Immune checkpoint inhibitors (ICIs) like anti-PD1 therapies can induce gastritis.
- Cytomegalovirus (CMV) reactivation is a potential complication in immunocompromised patients.
- The interplay between ICI-induced gastritis and CMV reactivation requires further investigation.
Approach:
- A case of severe anti-PD1 inhibitor-induced gastritis with concurrent CMV reactivation was analyzed.
- A systematic literature review identified 5 similar cases of immune-related gastritis and CMV reactivation.
- Clinical outcomes and treatment responses were evaluated.
Key Points:
- Concurrent CMV reactivation can significantly complicate ICI-induced gastritis.
- Systematic review identified a limited number of associated cases, highlighting rarity but clinical significance.
- Ganciclovir demonstrated clinical improvement in the majority of patients treated for CMV reactivation.
Conclusions:
- Early diagnosis of CMV infection is crucial for managing severe or refractory immune-related gastritis.
- Targeted antiviral therapy (ganciclovir) can lead to clinical improvement.
- Prompt CMV treatment may prevent the need for escalating immunosuppressive therapy.
Introduction:
Reactivation of cytomegalovirus can complicate the evolution of patients with gastritis induced by immune checkpoint inhibitors.
Methods:
The experience in our center is described and a review of the literature is performed.
Results:
A case of severe gastritis induced by treatment with a programmed cell death receptor-1 (anti-PD1) inhibitor, associated with reactivation of cytomegalovirus (CMV) is described. In the systematic review, we identified 5 cases of immune-related gastritis associated with CMV reactivation. Ganciclovir treatment contributed to clinical improvement in most patients.
Conclusion:
The early identification of a CMV infection in patients with severe or refractory immune-related gastritis will allow the initiation of targeted treatment, and may avoid increasing immunosuppressive therapy.
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