S5106 Gastric CMV Presenting in an Immunosuppressed Patient With Multiple Sclerosis
Abstract
Introduction: Cytomegalovirus is a common viral infection that is associated with significant disease in immunocompromised patients, including those on immunomodulating medications. It can cause a broad range of clinical disease including hepatitis, esophagitis, and colitis. When associated with gastritis, symptoms can include epigastric pain, nausea/vomiting, fever and rarely hematemesis. We present a case of biopsy positive gastric CMV in a patient with MS receiving treatment with natalizumab. Case Description/Methods: A 65-year-old woman with a history of GERD on omeprazole twice daily and multiple sclerosis on natalizumab presented to the Emergency Department with abdominal bloating and epigastric pain. Vital signs were within normal limits. Labs were notable for mild LFT elevations. A computed tomography (CT) abdomen/pelvis with contrast was unremarkable except for a mildly enlarged spleen. Abdominal ultrasound was unremarkable. As workup was largely negative, she was discharged and followed up outpatient where she was started on dexlansoprazole. An esophagogastroduodenoscopy was performed, notable for gastritis and a fundic gastric polyp. Gastric biopsies obtained showed scattered positively staining structures suggestive of CMV inclusions. After following up with ID and further workup revealed CMV viral load of less than 200 with negative antibodies. After discussion with transplant infectious disease, it was determined that given the above results, there was no…
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