CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(04): E533-E536
DOI: 10.1055/a-0848-8172
Case report
Owner and Copyright © Georg Thieme Verlag KG 2019

Jejunal diaphragm disease associated with cytomegalovirus infection

Sumika Kagebayashi
Department of Gastroenterology, Kyoto University Graduate School of Medicine, Kyoto, Japan
,
Shuji Yamamoto
Department of Gastroenterology, Kyoto University Graduate School of Medicine, Kyoto, Japan
,
Hiroshi Seno
Department of Gastroenterology, Kyoto University Graduate School of Medicine, Kyoto, Japan
› Author Affiliations
Further Information

Publication History

submitted 04 September 2018

accepted after revision 26 November 2018

Publication Date:
03 April 2019 (online)

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Abstract

Background and study aims Diaphragm disease (DD) is a rare gastrointestinal disease featuring multiple thin, circumferential strictures in the intestine, related to prolonged intake of nonsteroidal anti-inflammatory drugs (NSAIDs). Here, we report a case of DD associated with cytomegalovirus (CMV) infection in a patient not taking NSAIDs. A 72-year-old man was referred to our hospital due to persistent epigastric pain. Push enteroscopy showed extensive mucosal detachment in the upper jejunum. Immunohistochemistry examination of biopsy specimens revealed CMV positivity. In addition, CMV antigenemia was positive. Antiviral treatment with ganciclovir improved his symptoms and the CMV antigenemia became negative. Wireless capsule enteroscopy performed 1 month after antiviral treatment showed regenerated mucosa and multiple diaphragm-like strictures in the jejunum, resulting in capsule retention. Balloon dilatation using double balloon enteroscopy (DBE) was performed and the capsule was retrieved endoscopically. DBE 6 months after antiviral therapy confirmed no recurrence of stenosis or inflammation. The patient had no history of long-term NSAID use. In a case of DD unassociated with NSAIDs, CMV infection should be considered in the differential diagnosis.