# Cytomegalovirus Gastritis Mimicking a Gastroesophageal Junction Malignancy in an AIDS Patient: A Case Report

## TL;DR

This case report describes a rare instance of CMV gastritis in an AIDS patient that mimicked a cancerous tumor at the stomach-esophagus junction.

## Contribution

The novelty lies in highlighting the rare endoscopic presentation of CMV gastritis at the gastroesophageal junction and its potential to mimic malignancy.

## Key findings

- CMV gastritis can present with endoscopic features resembling malignancy in AIDS patients.
- Immunohistochemistry is essential for accurate diagnosis of CMV gastritis.
- CMV ulcers at the GE junction are occasionally associated with underlying malignancy.

## Abstract

Cytomegalovirus (CMV) gastritis is a rare opportunistic infection that often affects immunosuppressed patients. It is a DNA virus belonging to the Herpes family most commonly spread through contaminated bodily fluids such as blood, urine, saliva, tears, breast milk, semen, and vaginal fluids. Here, we present a case of a newly diagnosed HIV-positive patient with acquired immunodeficiency syndrome (AIDS) found to have a gastroesophageal (GE) junction ulceration with endoscopic characteristics suggestive of malignancy due to CMV gastritis in the absence of underlying malignancy. Most immunocompetent patients experience mild or no symptomatology and thus often require no treatment. On the contrary, immunosuppressed patients may be greatly affected by CMV including death. Because of this, it is necessary to treat and potentially prophylax against CMV within this population depending on the severity of immunocompromise and overall clinical suspicion. The most common treatments include ganciclovir, valganciclovir, cidofovir, and foscarnet. This case highlights the rare location and endoscopic appearance of CMV gastritis. Since the endoscopic appearance of CMV is highly variable, immunohistochemistry of biopsied mucosa is the only reliable method to correctly diagnose. In addition, this case illustrates the importance of maintaining a broad differential including rare and treatable diseases. Lastly, it summarizes the observed association of CMV ulcers at the GE junction with underlying malignancy reported in the literature.