Cutaneous ulcer as leading symptom of systemic cytomegalovirus infection

Area of Science:

• Infectious Diseases
• Dermatology
• Immunology

Background:

• Cytomegalovirus (CMV) infection typically presents systemically, with skin ulcerations being an uncommon manifestation.
• Chronic immunosuppression, particularly after regimen changes, increases the risk of opportunistic infections like CMV reactivation.

Purpose of the Study:

• To report a case of severe systemic CMV infection presenting with unusual leg ulcerations in an immunosuppressed patient.
• To highlight the importance of considering CMV in the differential diagnosis of new-onset skin lesions in immunocompromised individuals.

Main Methods:

• A case report detailing a 64-year-old woman with mixed connective tissue disease on chronic immunosuppression.
• Clinical presentation, diagnostic investigations including skin biopsy with immunohistochemistry, and treatment response were documented.

Main Results:

• The patient developed severe systemic CMV viremia, fulminant hepatitis, encephalopathy, and pancytopenia.
• Skin ulcer biopsy confirmed CMV infection in endothelial cells, correlating with systemic disease.

Conclusions:

• New-onset skin ulcers in immunosuppressed patients, especially with recent changes in immunosuppression, warrant high suspicion for CMV reactivation.
• Prompt cessation of immunosuppression and initiation of antiviral therapy (ganciclovir) led to rapid improvement of both systemic and cutaneous manifestations.