PMC4531948_01
Surgical specimen of jejunum a: Several discrete ulcers, irregular in shape and size, are seen. Intervening mucosa showed irregularity, nodularity, and pseudopolyp appearance, b: The ulcer base consist of necrotic exudate.
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Grossly, there were multiple ill-defined ulcerations surrounded by irregular nodularities of mucosa(Fig 1 a, b).
a: Cytomegalovirus inclusions in endothelial cells of jejunum. There are many enlarged cells with purple cytoplasmic inclusions in submucosa and muscle layer of ulceration area(H&E stain x400). b: CMV inclusion body in glandular cells of endoscopic biopsy specimen of stomach(H&E stain x400).
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It suggested the cytomegalovirus infection of jejunum(Fig 2 a). On histologic examination of endoscopic biopsy specimen of esophagus and stomach, there were small basophilic inclusion bodies in endothelial cells and glandular cells(Fig 2 b).
a: In paraffin-embedded surgical specimen of jejunum, immunohistochemical stain using monoclonal antibody for CMV PP65 antigen showed strong positive reaction in epithelial layer(x400). b: Also, positive stains were noted in cytospin preparation and peripheral neutrophils(x400).
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APAAP(alkaline phosphatase antialkaline phosphatase)(Clonal CMVKit, Biotest, Germany) method(Fig 3 b). Also, IF stain using DAKO-CMV, DDG9 and CCH2(DAKO, USA) for immediate early CMV antigen was performed from urine shell vial culture which showed heavy CMV infection.