Cytomegalovirus associated oral ulcerations in HIV‐infected patients

Abstract

Oral ulcerations associated with disseminated cytomegalovirus (CMV) infection were observed in four patients with AIDS manifestations showing low CD4 counts. Virus cultures of urine and saliva samples were positive for CMV in all cases. The lesions were characterized by a punched-out appearance, non-indurated borders, low bleeding tendency and lack of inflammatory wall. Light microscopy revealed granulation tissue containing "owl's eye" like cells in all specimens. Presence of CMV was confirmed by immunohistochemistry and in situ hybridization. The ulcerations were infiltrated with T-lymphocytes of the helper, suppressor and cytotoxic subset, most were positive for HLA DR. Despite the local invasion with immunocytes and high serum titers of serum antibodies the patients experienced progressive CMV disease.

Oral ulceration associated with concurrent herpes simplex virus, cytomegalovirus, and Epstein-Barr virus infection in an immunocompromised patient

“…Oral manifestations of CMV infection have been well documented in solid organ and bone marrow transplant recipients, as well as in patients with AIDS. [10][11][12][13][14][15][16][17] Intraoral CMV infections have been reported to involve any mucosal site. Most patients have nonspecific chronic ulcerations that show CMV-related cytopathic effect on biopsy.…”

“…Finally, oral lesions attributable to HHV-5, or cytomegalovirus (CMV), have been documented in patients with various immunosuppressive conditions, such as acquired immunodeficiency syndrome (AIDS), lymphoproliferative disorders requiring a bone marrow transplantation, and iatrogenic immunosuppression after organ transplantation. [10][11][12][13][14][15][16][17] In these cases, CMV-related oral lesions commonly appear as chronic mucosal ulcerations and will occasionally demonstrate histopathologic evidence of coinfection by HSV. [17][18][19][20][21][22] As mentioned earlier, simultaneous infection by 2 different herpesviruses has been documented.…”

HIV/AIDS and Oral Health in Socially Disadvantaged Communities

“…These ulcers can appear on any mucosal surface and may be confused with aphthous ulcers , necrotizing ulcerative periodontitis (NUP), (Dodd et al, 1993), and lymphoma. Unlike aphthous ulcers, however, which usually have an erythematous margin, CMV ulcers appear necrotic with a white halo, (Langford et al, 1990). Diagnosis of CMV ulcers is made from a biopsy but immunohistochemistry may be helpful.…”

Human cytomegalovirus-associated oral and maxillo-facial disease

“…Human cytomegalovirus (HCMV) is an omnipresent pathogen, with a seroprevalence among adults of 50-100%. Seropositivity against HCMV reaches 50-80% in heterosexual individuals who are seronegative for human immunodeficiency virus (HIV), whereas homosexual HIV-seropositive males are almost always seropositive for HCMV [1]. Seroconversion is also prominent among individuals with poor socio-economic status and ⁄ or in developing countries [2].…”