Summary:Unusual cytomegalovirus (CMV)-related complications were seen after autologous stem cell transplantation (SCT) in a 50-year-old patient with diffuse large B cell lymphoma. One month after SCT, the patient developed life-threatening upper gastrointestinal tract (GIT) bleeding with several episodes of hemorrhagic shock. Endoscopy and subsequent explorative laparotomy revealed deep-seated bleeding ulcers containing intracellular CMV inclusion bodies distributed extensively in the GIT, from the lower esophagus to the small bowel. Later, she developed gradual loss of consciousness with communicating hydrocephalus which was possibly secondary to CMV-induced ventriculitis. She recovered completely after insertion of a ventriculostomy and subsequent V-P shunt. Bone Marrow Transplantation (2002) 29, 715-716. DOI: 10.1038/sj/bmt/1703519 Keywords: gastrointestinal tract hemorrhage; autologous transplantation; lymphoma; hydrocephalus; CMV CMV antigenemia is common early after autologous or allogeneic stem cell transplantation (SCT), 1 but usually lacks any clinical significance. The lung is the organ most susceptible to invasive CMV infection, although this occurs infrequently after autologous SCT.2 Rare sites of CMV infection post autologous SCT include the gonads 3 and the gastrointestinal tract (GIT). 4 The following case report describes an unusual clinical course of CMV infection early after autologous SCT.A 50-year-old female who had stage 4B diffuse large B cell lymphoma involving the adrenal glands, uterus, ovaries and abdominal lymph nodes with markedly elevated LDH (4000 IU), achieved complete remission after six cycles of CHOP. She was maintained on a continuous low dose of prednisone (5 mg daily) because of Addison's disease caused by adrenal involvement by lymphoma. Four months later, she underwent autologous PBSCT using the TECAM conditioning regimen (etoposide, thiotepa, cytarabine, cyclophosphamide and melphalan) with engraftment on day ϩ25. On day ϩ30 she complained of abdominal pain which was followed by massive upper GIT bleeding. During the following days, several episodes of hemorrhagic shock occurred. Endoscopy and subsequent explorative laparotomy revealed many deep-seated bleeding ulcers along the lower esophagus, stomach and jejunum (Figure 1). Biopsy revealed intracellular CMV inclusion bodies (Figure 2).