Cytomegalovirus gastritis as an initial manifestation of a patient with adult T-cell leukemia.

A 39-year-old woman was admitted to the hospital because of epigastric pain and diagnosed as having gastritis. After 3 months, she developed generalized lymphadenopathy, and a biopsy revealed diffuse proliferation of CD4 positive lymphoid cells. She was positive for human T-cell leukemia virus type-I antibody and the diagnosis of lymphoma-type adult T-cell leukemia (ATL) was made. Gastritis was proved to be caused by cytomegalovirus (CMV), since histologic examination of the gastric biopsy specimen disclosed typical cytomegalic inclusions. CMV infection in ATL patients is usually generalized and complicated at the terminal phase of the disease. This patient had an unusual form of CMV infection which showed isolated stomach involvement; it preceded the full appearance of ATL and thus was the initial manifestation of the disease.