Intractable Pruritus as Initial Presentation of Cytomegalovirus -Tuberculosis Coinfections

Coinfection of cytomegalovirus (CMV) and Mycobacterium tuberculosis presenting with acquired perforating dermatosis is a rare occurrence and remains poorly described in the literature. A man in his 40s, a farmer and chronic smoker, who was partially treated for tuberculosis, presented with a history of fever, weight loss, cough, generalized lymphadenopathy, severe pruritus, and skin lesions. Imaging findings suggested tuberculosis, which was confirmed by sputum examination. Histopathological examinations confirmed CMV lymphadenitis associated with acquired perforating dermatosis. Treatment included antitubercular therapy and a multidrug regimen for severe pruritus, leading to symptomatic improvement. Despite initial progress, the patient was lost to follow-up and later succumbed at home, emphasizing the importance of timely intervention for coinfected tuberculosis and cytomegalovirus diseases. This case highlights the rarity of cytomegalovirus and tuberculosis coinfection, the diagnostic complexities, the challenges associated with the treatment of intractable pruritus, and the necessity of ensuring proper follow-up.