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
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.
