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

Figure 1 Endoscopic findings of tumor, post-endoscopic submucosal dissection ulcer and triamcinolone acetonide injection. A: An narrow band imaging endoscopic image reveals a flat, early gastric cancer lesion extending over the gastric outlet to the pylorus (yellow arrows); B: A post-endoscopic submucosal dissection artificial ulcer covering two-thirds of the circumference of the pylorus (blue curved arrow); C: The ulcer floor covered by a thick layer of white moss; D: Triamcinolone acetonide (2 mL) was injected locally at each site (red arrow).

Figure 2 Endoscopic findings of cytomegalovirus associated ulcer and microscopic examination. A: Artificial ulcer on postoperative day 12, showing the formation of abundant granulation tissue and a 10-mm-deep ulcer at the center of the granulation tissue (yellow arrows); B: The healing process of the deep ulcer (blue arrows) on postoperative day 15; C: A biopsy from the deeper ulcer margin revealed large cells with intranuclear inclusion bodies (black arrow, HE staining, × 600); D: Large cells with intranuclear inclusion bodies stained positive for anti-cytomegalovirus (CMV) antibodies (red arrows, anti-CMV antibody immunohistochemical staining, × 600).