Diagnosis: Infection with CMV.
MICROSCOPIC FINDINGS AND CLINICAL COURSE
A skin biopsy specimen from the border of the ulcer demonstrated endothelial cell nuclear inclusions with a clear halo and cytoplasmic perinuclear inclusions consistent with CMV infection (Figure 3). These findings were confirmed by immunohistochemical tests for CMV antigen. Histologic and immunohistochemical studies revealed no evidence of HSV infection within or surrounding the ulcer.
Figure appears in full text version.
|
|
|
|
|
The patient died 2 months after the initiation of intravenous cidofovir therapy (5 mg/kg every 2 weeks) for the CMV ulcer and retinitis. The perianal ulcer was stable in size during the cidofovir treatment.
DISCUSSION
Cytomegalovirus can cause retinitis, pneumonitis, and gastrointestinal ulcers in immunocompromised patients. There is controversy as to whether chronic perianal ulcers that demonstrate CMV in such patients are a result of primary infection with CMV or whether the virus is a bystander.1 Reported cutaneous manifestations of CMV infection include ulcers, verrucous lesions, purpuric papules, prurigo nodularis, and morbilliform eruptions, . . . [Full Text of this Article]
