Subhadeep Banerjee¹, Dawesh Prakash Yadav¹*, Sunit Shukla¹, Anurag Kumar Tiwari¹, Vinod Kumar¹, Sarita Mittal², Latika Gupta², Vinit Kumar¹, Nitesh Kumar Patel¹ and Ajay Singla¹

¹Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
²Department of Histopathology, National Reference Laboratory, Pathkind Labs, Gurugram, Haryana, India

*Corresponding Author: Dawesh Prakash Yadav, Associate Professor and Head, Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu Uni- versity, Varanasi, India.

Received: March 18, 2026; Published: June 08, 2026

Abstract

Background: Cytomegalovirus (CMV) gastritis in immunocompetent adults is uncommon and may mimic peptic ulcer disease, gastric malignancy or severe inflammatory disease. Validated thresholds for tissue CMV DNA quantification in such adults are undefined, and correlations with clinical severity are inconsistent.

Case Presentation: A 51-year-old immunocompetent woman presented with epigastric pain and anemia. Upper gastrointestinal endoscopy revealed extensive gastric ulceration involving approximately 50% of the mucosal surface with friable mucosa and contact bleeding. Histopathology demonstrated characteristic cytomegalic inclusion bodies, confirmed by immunohistochemistry. Quantitative tissue PCR showed a high viral load of 30,321,269 copies/mg tissue (7.48 log₁₀ copies/mg). The patient received intravenous pantoprazole and ganciclovir for 2 weeks, followed by oral valganciclovir for 4 weeks. Symptoms improved rapidly and repeat endoscopy with biopsy at six weeks demonstrated complete mucosal healing with no detectable CMV.

Discussion: This case highlights extensive gastric ulceration by CMV with markedly elevated tissue viral load in an immunocompetent host. Possible mechanisms include endothelial infection, microvascular ischemia and inflammatory amplification.

Conclusion: CMV gastritis should be considered in immunocompetent patients presenting with extensive gastric ulceration. Tissue PCR may facilitate diagnosis, and antiviral therapy can lead to rapid clinical and endoscopic resolution.

Keywords: Cytomegalovirus Gastritis; Immunocompetent Host; Gastric Ulceration; Tissue Viral Load; Cytomegalovirus PCR

References

1. Beany A and Rainis T. “CMV-Related Gastric Ulcer and Gastroduodenitis in an Immunocompetent Patient: A Case Report and Literature Review”. Case Reports in Gastrointestinal Medicine 2021 (2021): 3513223.
2. Rafailidis PI., et al. “Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review”. Virology Journal 5 (2008): 47.
3. Kim KH., et al. “Cytomegalovirus-associated gastritis in immunocompetent adult”. Korean Journal of Internal Medicine4 (2004): 260-263.
4. Goodgame RW. “Gastrointestinal cytomegalovirus disease”. Annals of Internal Medicine9 (1993): 924-935.
5. Goodman AL., et al. “CMV in the gut: a critical review of CMV detection in the immunocompetent host with colitis”. European Journal of Clinical Microbiology & Infectious Diseases1 (2015): 13-18.
6. Phyun L., et al. “A Case of Cytomegalovirus Gastric Ulcer Mimicking Gastric Cancer in an Immunocompetent Host”. Korean Journal of Gastroenterology5 (2004): 284-287.
7. Chetty R and Roskell DE. “Cytomegalovirus infection in the gastrointestinal tract”. Journal of Clinical Pathology 11 (1994): 968-972.
8. Nakase H and Herfarth H. “Cytomegalovirus Colitis, Cytomegalovirus Hepatitis and Systemic Cytomegalovirus Infection: Common Features and Differences”. Inflammatory Intestinal Diseases1 (2006): 15-23.
9. Yoon J., et al. “Endoscopic features and clinical outcomes of cytomegalovirus gastroenterocolitis in immunocompetent patients”. Scientific Report1 (2021): 6284.
10. Kinoshita Y., et al. “Cytomegalovirus mononucleosis--associated gastric ulcers in normal host”. Gastroenterology Jpn1 (1993): 88-94.
11. Karigane D., et al. “Cytomgalovirus enteritis in immunocompetent subjects: a case report and review of the literature”. Journal of Infection and Chemotherapy5 (2014): 325-329.
12. Jentzer A., et al. “Cytomegalovirus and Inflammatory Bowel Diseases (IBD) with a Special Focus on the Link with Ulcerative Colitis (UC)”. Microorganisms7 (2020): 1078.
13. Lawlor G and Moss AC. “Cytomegalovirus in inflammatory bowel disease: pathogen or innocent bystander?” Inflammatory Bowel Disease9 (2010): 1620-1627.
14. Sinclair J and Sissons P. “Latency and reactivation of human cytomegalovirus”. Journal of General Virology 7 (2011): 1763-79.
15. Baig MA., et al. “Cytomegalovirus Gastritis In Immunocompetent Patient: Case Report And Review Of Literature”. Internet Journal of Infectious Diseases1 (2005).
16. Crespo P., et al. “Gastritis as a manifestation of primary CMV infection in an immunocompetent host”. BMJ Case Report (2015): bcr2014206991.
17. Maderuelo Gonzalez E., et al. “CMV Gastritis in an immunocompetent patient as a manifestation of primary infection”. Endoscopy 55 (2023): eP368V.
18. Paladiya R., et al. “S4243 Unmasking the Silent Culprit: Cytomegalovirus Gastritis Striking an Immunocompetent Host!” American Journal of Gastroenterology10S (2023): S2682.
19. Solito S., et al. “Cytomegalovirus-Related Gastritis in an Immunocompetent Host Presenting With Infectious Gastroparesis”. ACG Case Report Journal12 (2023): e01231.

Citation

Citation: Dawesh Prakash Yadav., et al. “Extensive Cytomegalovirus Gastritis with High Tissue Viral Load in an Immunocompetent Host: A Case Report". Acta Scientific Gastrointestinal Disorders 9.3 (2026): 01-08.

Copyright

Copyright: © 2026 Dawesh Prakash Yadav., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.