2012 Volume 45 Issue 3 Pages 250-257
We report a rare case of gastric perforation due to cytomegalovirus infection that required surgical treatment. A 41-year-old man presented weight loss, low grade fever, and vomiting. Upper gastrointestinal endoscopy showed a large ulcer on the antrum of the stomach. The biopsy specimen of the ulcer showed cytomegalic cells with intranuclear inclusion bodies and blood test was positive for human immunodeficiency virus (HIV) antibody. A diagnosis of cytomegalovirus (CMV) infection of the stomach due to acquired immunodeficiency syndrome (AIDS) was made and he was admitted to our hospital. We conducted conservative medical therapy with a proton pump inhibitor (PPI) and antiviral agent. However, we could not continue antiviral therapy due to pancytopenia. Three weeks later he had abdominal pain, and upper gastrointestinal endoscopy showed a huge perforation of the ulcer on the antrum of the stomach. The abdominal CT showed a large quantity of free air and ascites. Based on the diagnosis of ulcer perforation due to cytomegalovirus infection of the stomach, we conducted emergency laparotomy. Laparotomy revealed a large perforated ulcer (approximately 4 cm in diameter) on the antrum of the stomach, and we performed distal gastrectomy. The resected specimen showed a cytomegalic cell infiltration 11 mm apart from the ulcer margin. Although his condition was improved, AIDS progressed gradually and he died 239 days after the operation.