Recurrent gastrointestinal bleeding caused by cytomegalovirus duodenitis

A 78-year-old male hospitalized due to acute pneumonia presented with hematemesis, melena and hypotension. Past medical history was relevant for prostate cancer with bone and lung metastasis under systemic chemotherapy. Upper gastrointestinal endoscopy revealed a 50mm serpiginous ulcer in the second portion of the duodenum with a visible vessel (Forrest IIa). Hemostatic therapy with adrenaline, polidocanol and one clip placement was performed. Biopsies of the ulcer were also obtained. During hospitalization the patient developed recurrent gastrointestinal bleeding requiring several red blood cell transfusions and endoscopic reintervention. Further histopathologic evaluation revealed chronic duodenitis caused by cytomegalovirus (CMV) infection. Considering the poor performance status and successful hemostasis with ulcer healing, antiviral treatment was not initiated. The patient died a few weeks later due to neoplastic disease progression.