S6200 Pseudo-Tumors of the Duodenum Related to Cytomegalovirus Infection

Introduction: Cytomegalovirus (CMV) infection can affect any part of the gastrointestinal (GI) tract, with the colon being the most frequently involved site, followed by the esophagus and stomach. Endoscopic findings typically include mucosal erythema, edema, pseudo-membranes, “punched-out” and “cobblestone-like” ulcerations. In rare cases, cytomegalovirus infection can mimic tumors or neoplasms. Case Description/Methods: We present a 61-year-old White man with end-stage renal disease status post-renal transplantation (12 months ago) presented with 2 days of fever, nausea and non-bloody emesis. He did endorse poor appetite, heartburn and a 7 lb weight loss over the previous 2 weeks. Upper Endoscopy revealed multiple tumor-like masses measuring 7-20 mm in the visualized duodenum. Biopsies showed duodenal mucosa with reactive changes, and immunostaining was positive for cytomegalovirus infection. There was no evidence of malignancy or lymphoma. cytomegalovirus polymerase chain reaction returned as 4140 IU/mL. He was treated with intravenous ganciclovir with improvement in his GI symptoms. He was discharged to complete a course of oral ganciclovir therapy. Surveillance endoscopy after 8 weeks demonstrated resolution of the duodenal masses. Discussion: We present here a case of CMV-associated pseudo-tumors of the duodenum. They are rare, tumor-like inflammatory lesions that form as a result of both direct viral infection and a robust localized immune response resulting in a mass-like appearance. Although the right colon is most commonly affected, pseudo-tumors have been reports throughout the GI tract. Radiologic and endoscopic findings may mimic malignancy, making histologic evaluation critical for diagnosis. Differential diagnoses include colorectal cancer, lymphoma, Kaposi sarcoma, inflammatory bowel disease, and infectious granulomatosis. Early recognition and appropriate antiviral treatment are essential to avoid unnecessary surgery and improve clinical outcomes. Since these pseudo-tumors respond to medical treatment, it is important for physicians treating immunocompromised patients to be aware of this disease entity.