Cytomegalovirus gastritis - 23/08/11
Doi : 10.1016/j.gie.2008.02.020
Lawrence J. Brandt, MD, Associate Editor, for Focal Points
| Commentary The great impersonators of the classic age of medicine were syphilis and tuberculosis, to which renal cell carcinoma, lymphoma, and systemic lupus erythematosus were added later. With the advent of AIDS, Cytomegalovirus (Greek: cyto, cell; megalo, large) became another important impersonator. Think CMV today whenever you see ulcers, polypoid lesions, strictures, and what appears to be “itis,” be it esophagitis, gastritis, enteritis, colitis, pancreatitis, cholecystitis, or even hepatitis. As for why this elderly man has CMV, it is likely the virus was reactivated because of the immunosuppression caused by the prednisone, perhaps in combination with his advancing age. HIV is another possibility, not always tested for; never make judgments, rather do the test and make the diagnosis. And when obtaining biopsy specimens of an ulcer, remember that the more specimens that are taken, with 6 being the minimum, the greater the chance of diagnosing CMV—and take them from the edge of the ulcer as well as the center; CMV likes vascular endothelium, mucosal epithelium, and connective tissue stromal cells. The intranuclear inclusion body giving the appearance of an owl’s eye is an insensitive but highly specific finding for CMV. Owls’ eyes have an abundance of rods and therefore are capable of remarkable black and white vision. When looking for owl eyes in histologic sections, we should also emulate their behavior to look forward and see clearly, but at the same time remember that most of life’s situations are not black and white, but rather shades of gray. Things may not be what they appear to be at first glance. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2008
American Society for Gastrointestinal Endoscopy. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
Vol 68 - N° 2
P. 370-371 - agosto 2008 Ritorno al numero
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