Cytomegalovirus (CMV) Gastritis

52-year-old patient who underwent renal transplant two year prior, presented with abdominal pain and nausea. Esophagogastroduodenoscopy demonstrated mild antrum erythema and one erosion (A). The erosion was biopsied, in addition to antrum and body biopsies. Histology (hematoxillin & eosin) revealed inclusion bodies (B). The typical “owls eye appearances” are demonstrated on panel C. Immunohistochemical stains confirmed the presence of CMV

Cytomegalovirus (CMV) disease of the gastrointestinal (GI) tract is a major cause of morbidity and mortality in immunocompromised patients. 

However, upper GI CMV disease can occur in the absence of immunodeficiency and immunosuppression. CMV is usually symptomatic, and mucosal erosion and ulceration are often evident at esophagogastroduodenoscopy. Obtaining sufficient biopsies (i.e. at least 4, two from the border and two from the ulcer base) are essential to allow the pathologist to diagnose this surreptitious organism.