Cytomegalovirus-induced Oral, Esophageal, Gastric and Colonic Ulcers in an Immunocompetent Patient

Abstract

Cytomegalovirus (CMV) is a globally prevalent pathogen, with the gastrointestinal (GI) tract being one of the most frequently affected targets. On the other hand, the simultaneous involvement of multiple GI organs in immunocompetent individuals has rarely been reported, and CMV-induced oral ulcers are uncommon. A 70-year-old man presented to the emergency clinic with dyspnea and epigastric discomfort. He had no known conditions that could compromise his immune system and no history of immunosuppressive medication use. A physical examination revealed anemic conjunctiva, and a digital rectal examination revealed melena. GI endoscopy identified ulcers in the oral cavity, esophagus, stomach, and colon, and the histopathological examination confirmed CMV positivity in each ulcer. After a 21-day course of intravenous ganciclovir, follow-up endoscopy revealed healed ulcers. This report shows that CMV can simultaneously affect the oral cavity and multiple GI organs, even in immunocompetent patients. A prompt histopathological evaluation is essential for an accurate diagnosis and timely treatment to prevent further complications.

Keywords: Cytomegalovirus; Ganciclovir; Immunocompetence; Oral ulcer; Peptic ulcer.