What happened, in summary

A woman with CTLA4 insufficiency developed EBV-associated, poorly differentiated gastric adenocarcinoma at age 41. Her underlying immune disorder had caused antibody deficiency, severe diarrhea and chronic kidney problems, but the gastric cancer became a separate major part of her medical journey.

The cancer was initially treated with radical endoscopic mucosal resection. Three years later it recurred and was again EBV-associated. She then underwent total gastrectomy at age 44. Nineteen lymph nodes removed with the stomach were negative for cancer, and she reached complete remission after the operation.

Her immune and gastrointestinal disease continued to require treatment. Abatacept had been stopped after rising EBV levels and was later resumed after healing of her severe enteropathy. These immune-directed treatments were used for her CTLA4-related illness rather than the gastric cancer.

At the latest description she was 47 and her intestinal symptoms were well controlled. Her gastric-cancer outcome remained complete remission after the total gastrectomy, placing her roughly 3 years beyond surgery for the recurrence.