Mori H, Fujihara S, Nishiyama N, Kobara H, Oryu M, Kato K, Rafiq K, Masaki T. Cytomegalovirus-associated gastric ulcer: A side effect of steroid injections for pyloric stenosis. World J Gastroenterol 2013; 19(7): 1143-1146 [PMID: 23467493 DOI: 10.3748/wjg.v19.i7.1143]
Corresponding Author of This Article
Hirohito Mori, MD, PhD, Department of Gastroenterology and Neurology, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793, Japan. hiro4884@med.kagawa-u.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Hirohito Mori, Shintaro Fujihara, Noriko Nishiyama, Hideki Kobara, Makoto Oryu, Kiyohito Kato, Tsutomu Masaki, Departments of Gastroenterology and Neurology, Kagawa Medical University School of Medicine, Kagawa 761-0793, Japan
Kazi Rafiq, Departments of Pharmacology, Kagawa Medical University School of Medicine, Kagawa 761-0793, Japan
Author contributions: Mori H was responsible for conception of the research and for drafting the article; Fujihara S, Nishiyama N, Kobara H, Oryu M, Kato K and Rafiq K participated equally in the work; Masaki T provided critical revision of the manuscript for intellectual content and was responsible for final approval of the manuscript.
Correspondence to: Hirohito Mori, MD, PhD, Department of Gastroenterology and Neurology, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793, Japan. hiro4884@med.kagawa-u.ac.jp
Telephone: +81-87-8912156 Fax: +81-87-8912158
Received: September 24, 2012 Revised: November 13, 2012 Accepted: December 25, 2012 Published online: February 21, 2013 Processing time: 150 Days and 20.6 Hours
Abstract
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.
