CUTANEOUS CYTOMEGALOVIRUS INFECTION
By Gary M. White, MD
Cytomegalovirus (CMV) is a common virus that usually does not cause disease. However, in immunocompromised hosts, it can cause a variety of skin lesions, including ulcers.
Individual case reports have documented a wide variety of skin lesions in both normal and compromised hosts including maculopapular, urticarial, and scarlitiniform eruptions, crusted papules, nodules, and verrucous, papulopustular or vesicobullous lesions. The classic presentation however of CMV lesions in immunocompromised patients (e.g. AIDS) is an ulcerative lesions, usually of the oral mucosa, but also of the genital and perineal region. One case of an HIV-positive infant with scalp ulcers was reported [Peds Derm 2014;31;729]. CMV may reactivate win the setting of acute Graft vs. Host disease.
Possible CMV Presentations
- Exanthem, yet “normal” viral titers are negative
- Reactivation in DRESS.
- Chronic ulcers, vasculitis, unexplained petechiae or purpura (especially in an immunocompromised patient)
- Baby with nodules, vesicles, purpura or petechiae
- Acute urticaria or Gianotti-Crosti
- Patient has skin lesions of any sort and has: AIDS, transplant or exposure to alemtuzumab
- Diagnosis traditionally has been made by finding CMV inclusion bodies histologically.
- Fast test: shell vial assay (tissue culture) to detect antibodies
- Slow test: culture CMV from fibroblasts
- New Gold Standard: Blood PCR levels
Referral to an infectious disease specialist is in order. For a mononucleosis-like syndrome in a an immunocompetent host, supportive care only is needed. For immunocompromised patients, ganciclovir, valganciclovir and foscarnet for resistant strains have been used.
A 23-year-old man with common variable immunodeficiency and a large eroded plaque on the right cheek. British J Dermatology Jan 2014
Heart transplant patient with an ulcer on the leg. JAMA Derm 2015;151;661
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