CMV gastritis in the immunocompetent host

We report a case of CMV gastritis in a 78 year old immunocompetent male with a blank medical history. He presented with symptoms of anorexia, nausea, mild epi- gastric discomfort and a weight loss of three kilograms. The clinical examination was unremarkable. Blood analysis showed a reactive lymphocytosis with mild elevation of liver enzymes (AST 41 U/L [< 37 U/L], ALT 57 U/L [< 41 U/L], LDH 673 U/L [< 530 U/L]) and C-reactive protein (6 mg/L [< 5 mg/L]). Abdominal ul- trasound was normal. Gastroscopic examination revealed a diffuse gastritis with erosions and multiple, elevated ulcerations with a centrally localised crater. On patho- logical examination an active and focal erosive gastritis was documented. Numerous cells exhibited nuclear in- clusions suggesting CMV gastritis (Fig. 1). Helicobacter pylori testing was positive. IgM anti-CMV and IgG anti- CMV serum antibodies were positive, with low IgG avidity suggesting a recent infection. HIV serology was negative. The patient was treated with proton pump in- hibitors and made a full recovery.