Cytomegalovirus-Associated Gastroduodenal Ulcers in a Patient With Functional Hypercortisolism: A Case Report

Abstract

Cytomegalovirus (CMV)-associated gastroduodenal ulcers (GDU) are a rare digestive disease, which principally affect immunocompromised patients. We recently experienced CMV-associated GDU occurring in a seemingly immunocompetent patient. The rarity of such a condition was inimical to a correct clinical diagnosis.A 77-year-old woman with Alzheimer's disease was admitted to our hospital because of vomiting and anorexia. Her general condition was extremely poor due to severe dehydration. Any invasive procedures including gastroduodenal endoscopy could not be performed. Laboratory test results showed electrolyte imbalance, hyperglycemia, and hypercortisolemia. The plasma adrenocorticotropic hormone level was rather low. On her 11th day in hospital, she suddenly fell into shock status. Despite intensive care, the patient could not be rescued. An autopsy was performed and revealed that she had suffered from CMV-associated GDU and died of candidemia that invaded through the ulcer. Her adrenal glands showed neither neoplasm nor hyperplasia, suggesting that her hypercortisolism was a purely functional disorder. We concluded that the severe opportunistic infections were developed in association with functional hypercortisolism.This case suggests that functional hypercortisolism, even though transient, can cause a patient to be immunocompromised.

FIGURE 1

Transitions in laboratory test results of the patient.

FIGURE 2

Histopathological findings at autopsy. (A) A deep gastric ulcer (asterisk) associated with fungal colonization (hematoxylin-eosin; loupe magnification). (B) Fungi invading the vascular lumen (arrowheads) in the ulcer bed (periodic acid-Schiff stain; low magnification). (C) Many CMV-infected cells (arrows) in mucosa adjacent to the ulcer (hematoxylin-eosin; high magnification).

FIGURE 3

Cut-surfaces of the adrenal glands. No neoplastic/hyperplastic changes are seen.