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Case Reports in Pediatrics
Volume 2017, Article ID 2412930, 4 pages
https://doi.org/10.1155/2017/2412930
Case Report

Cytomegalovirus Associated Duodenal Ulcer and Duodenitis in a Malnourished Pediatric Patient

1Pediatric Residency Program, Our Lady of the Lake Children’s Hospital, Baton Rouge, LA, USA
2Our Lady of the Lake Children’s Hospital, Baton Rouge, LA, USA

Correspondence should be addressed to Rachel Bernard; moc.cmrlolo@2dranreB.lehcaR

Received 23 May 2017; Revised 21 August 2017; Accepted 7 September 2017; Published 8 October 2017

Academic Editor: Bernhard Resch

Copyright © 2017 Rachel Bernard et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Cytomegalovirus (CMV) duodenitis is a rare occurrence, especially in pediatric patients. A thirteen-month-old female presented to the Emergency Department for a febrile seizure. She was incidentally admitted for severe malnutrition with an initial workup remarkable for only a slight elevation in her ALT at 48. The patient was found to have an oral aversion requiring nasogastric tube feeds for adequate caloric intake. She continued to fail to gain weight and underwent an EGD that demonstrated a duodenal ulcer. She was consequently started on sucralfate and omeprazole. Post-EGD lab work demonstrated a pronounced increase in AST and ALT. Pathology from the EGD biopsies later demonstrated viral inclusion bodies consistent with CMV duodenitis. Apart from malnutrition, other causes of immune deficiency were eliminated from the differential diagnosis due to negative HIV PCR and normal immunoglobulins. While on antiviral treatment, her viral load of 1080 IU/mL trended to resolution and her liver enzymes normalized. The patient was ultimately discharged home demonstrating adequate weight gain via gastrostomy tube feeds. This case advocates for pediatricians to include immunodeficiency and infectious etiologies in their differential for malnourished patients in order to lead to earlier diagnosis and management of this treatable condition.