Cytomegalovirus-associated gastric ulcer: a side effect of steroid injections for pyloric stenosis.

Abstract

The local injection of triamcinolone acetonide (TA) is effective in preventing pyloric stenosis and deformity following large endoscopic submucosal dissection (ESD). However, because of its long-acting nature, TA can induce long-term local immunosuppression and subsequent adverse events. We report a case of a cytomegalovirus (CMV) ulcer that formed only at the TA local injection site. A 68-year-old man underwent ESD to treat early gastric cancer that formed over the pylorus. The lesion extended to the duodenum, and an artificial ulcer covered more than two-thirds of the circumference of the pylorus. To prevent pyloric stenosis, TA was locally injected into the ulcer floor. On day 12, a deeper ulcer 10 mm in diameter was discovered in the center of the post-ESD ulcer. Biopsies revealed large cells with intranuclear inclusion bodies, which stained positive for the anti-CMV antibody. Local TA injections are useful, however, CMV ulcer might occur as adverse events.

• Authors: Hirohito Mori, Shintaro Fujihara, Noriko Nishiyama, Hideki Kobara, Makoto Oryu, Kiyohito Kato, Kazi Rafiq, Tsutomu Masaki
• Journal: World journal of gastroenterology (World J Gastroenterol) Vol. 19 Issue 7 Pg. 1143-6 (Feb 21 2013) ISSN: 2219-2840 [Electronic] United States
• PMID: 23467493 (Publication Type: Case Reports, Journal Article)

Chemical References

• Immunosuppressive Agents
• Steroids
• Triamcinolone Acetonide

Topics

• Aged
• Biopsy
• Cytomegalovirus Infections (diagnosis, immunology, virology)
• Gastroscopy
• Humans
• Immunocompromised Host
• Immunosuppressive Agents (administration & dosage, adverse effects)
• Injections
• Male
• Pyloric Stenosis (prevention & control)
• Risk Factors
• Steroids (administration & dosage, adverse effects)
• Stomach Ulcer (diagnosis, immunology, virology)
• Time Factors
• Triamcinolone Acetonide (administration & dosage, adverse effects)
• Wound Healing