Tamura Jiro, Arakaki Shingo, Shibata Daisuke, Maeshiro Tatsuji
Department of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus, Nishihara, Okinawa, Japan.
BMJ Case Rep. 2013 Aug 30;2013:bcr2013010501. doi: 10.1136/bcr-2013-010501.
A 69-year-old woman presented with malaise. She had had organising pneumonia with the treatment of prednisolone. A diagnosis of fulminant hepatitis was made and steroid pulse therapy was initiated. Ten days later, a colonic resection with a colostomy was performed because of the perforated diverticulitis of the sigmoid colon. She presented with epigastric pain and melena after surgery. Despite the administration of the proton pump inhibitor, an endoscopy revealed multiple deep, punched-out ulcers of the stomach. Biopsy specimen showed cytomegalovirus (CMV) infection. The melena and CMV antigenemia was improved with ganciclovir; however the patient died from worsening of hepatic failure. We emphasise that CMV-associated gastric ulcers should be considered in the differential diagnosis of gastric ulcers in patients treated with immunosuppressive drugs.
一名69岁女性因身体不适前来就诊。她曾接受泼尼松龙治疗组织性肺炎。诊断为暴发性肝炎，并开始进行类固醇冲击疗法。10天后，因乙状结肠憩室炎穿孔行结肠切除术并造口术。术后她出现上腹部疼痛和黑便。尽管使用了质子泵抑制剂，但内镜检查发现胃内有多个深的、圆形溃疡。活检标本显示巨细胞病毒（CMV）感染。使用更昔洛韦后黑便和CMV抗原血症有所改善；然而，患者最终因肝功能衰竭恶化而死亡。我们强调，在对接受免疫抑制药物治疗的患者的胃溃疡进行鉴别诊断时，应考虑CMV相关性胃溃疡。
