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

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...

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Bibliographic Details
Published in:World journal of gastroenterology : WJG 2013-02, Vol.19 (7), p.1143-1146
Main Authors: Mori, Hirohito, Fujihara, Shintaro, Nishiyama, Noriko, Kobara, Hideki, Oryu, Makoto, Kato, Kiyohito, Rafiq, Kazi, Masaki, Tsutomu
Format: Article
Language:English
Subjects:
Aged
Biopsy
Case Report
Cytomegalovirus Infections - diagnosis
Cytomegalovirus Infections - immunology
Cytomegalovirus Infections - virology
Gastroscopy
Humans
Immunocompromised Host
Immunosuppressive Agents - administration & dosage
Immunosuppressive Agents - adverse effects
Injections
Male
Pyloric Stenosis - prevention & control
Risk Factors
Steroids - administration & dosage
Steroids - adverse effects
Stomach Ulcer - diagnosis
Stomach Ulcer - immunology
Stomach Ulcer - virology
Time Factors
Triamcinolone Acetonide - administration & dosage
Triamcinolone Acetonide - adverse effects
Wound Healing
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Summary: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.
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v19.i7.1143