SHM Converge Scientific Abstract ePoster Gallery-Through the Owl's Eyes: Cytomegalovirus Gastritis Imitating Gastric Cancer

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This poster describes an atypical case of cytomegalovirus (CMV) gastritis in an immunocompetent 82-year-old woman with cirrhosis who presented with abdominal pain and hematemesis. She had recurrent prior episodes of hematemesis, hypotension, tachycardia, ascites, anemia, and leukocytosis. CT imaging showed a large 5 x 10 x 9 cm multilobulated gastric mass eroding into the transverse colon with enlarged mesenteric lymph nodes, initially raising concern for gastric malignancy.<br /><br />The differential diagnosis included gastric adenocarcinoma, lymphoma, gastrointestinal stromal tumor, variceal bleeding, peptic ulcer disease, tuberculosis, abscess, and CMV gastritis. Endoscopy revealed a malignant-appearing ulcerated gastric mass. Biopsy demonstrated CMV gastritis with ulceration and viral inclusions (“owl’s eye” appearance), and H. pylori testing was negative. Paracentesis showed no malignancy or infection.<br /><br />The patient was treated with two weeks of oral valganciclovir and continued proton pump inhibitor therapy. At three-month follow-up, repeat endoscopy showed marked improvement in gastric erosions and ulcers, and CT imaging demonstrated a decrease in the size of the gastric mass and lymphadenopathy.<br /><br />The case emphasizes that CMV can cause severe gastrointestinal disease even in immunocompetent patients and may mimic gastric cancer radiographically and endoscopically. It also highlights the importance of early biopsy, histopathology, and multidisciplinary evaluation to avoid diagnostic anchoring on malignancy. In severe symptomatic cases, antiviral therapy such as valganciclovir may be beneficial.

Asset Subtitle

Mayanka Mahendran

Meta Tag

Author List Mayanka Mahendran, Philip K. Angelides

Category Clinical Vignettes

Concept Cytomegalovirus Gastritis

Concept Gastric Mass

Concept Biopsy

Concept Histopathology

Concept CMV Inclusion Bodies

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine

Presenting Author Mayanka Mahendran

Track Adult

Keywords

cytomegalovirus gastritis

CMV

immunocompetent

gastric mass

hematemesis

cirrhosis

valganciclovir

endoscopy

biopsy

gastric malignancy

Cytomegalovirus Gastritis

Gastric Mass

Biopsy

Histopathology

CMV Inclusion Bodies