Fatal gastrointestinal hemorrhage caused by cytomegalovirus duodenitis and ulceration after heart transplantation.

The case of a 61-year-old man, in whom heart transplantation was complicated by fatal gastrointestinal hemorrhage from duodenal ulcers 50 days after surgery, is described. Autopsy examination revealed extensive mucosal ulceration and hemorrhage into the bowel and peritoneal hemorrhage. Microscopy showed classical cytomegalovirus inclusions in clusters of cells in necrotic foci in the duodenum, lungs, and colon. This unusual case is the first reported example of cytomegalovirus-associated fatal gastrointestinal hemorrhage after heart transplantation. It is discussed in the context of the known features of the morbidity and mortality associated with cytomegalovirus infection in transplant patients.