38. Pyloric ulcer due to cytomegalovirus infection in a multiple myeloma patient

Cytomegalovirus (CMV) infection of the gastrointestinal tract is prevalent in immunosupressed patients, particularly after renal transplant, however it usually affects the oesophagus, small and large bowel and is quite rarely seen in the stomach. We report a case of pyloric canal ulcer due to CMV infection in a patient known with relapsed large B cell lymphoma and multiple myeloma. This 76-year-old female patient presented with both upper and lower abdominal pain, diarrhoea and loss of appetite. The diagnosis was complicated by the presence of acute diverticulitis, also diagnosed on this occasion. Gastroscopy revealed a superficial, oval ulcer in the pyloric canal. The definitive diagnosis was established histologically and confirmed by immunohistochemistry. Intranuclear and cytoplasmic CMV inclusions were abundantly present within the glandular epithelial cells, however, unusually, the endothelial cells were spared. The outcome has been favourable after a course of gancyclovir. Due to the patient’s co-morbidities, a repeat gastroscopy has not been organised, in view of the remission of symptoms.