Cytomegalovirus infection involving the skin in immunocompromised hosts. A clinicopathologic study

Cytomegalovirus (CMV) infection involving the skin in three transplant patients is presented. Patient 1, whose infection apparently was localized only to a cutaneous wound induced by extravasated ionotropic solution, survived. Mixed CMV and Candida infections developed in patient 2 in the cutaneous ulcer. He died of disseminated herpes simplex virus infection in two weeks. Patient 3 had CMV pneumonia and purpuric maculopapular eruption. He died of Pseudomonas sepsis 17 weeks later. Eighteen cases with CMV skin lesions are reported in the English literature. The clinical findings and the outcome of the current and the reported cases are analyzed. All patients were immunocompromised. CMV infection, when detected in the skin, appears to be associated with grave prognosis. Seventeen of 20 patients whose final outcome was recorded died within six months after the onset of CMV skin lesions. The outcome of one case is unknown. The mortality was 85%. The fatal cases had either concurrent disseminated CMV infection or mixed cutaneous or systemic infections. When the infection is localized in the skin wounds, the prognosis seems fairly good. All three such patients survived.