Perianal Cytomegalovirus Ulcer in an HIV Infected Patient: Case Report and Review of Literature

Nico, Marcello Menta Simonsen; Cymbalista, Natalia Cymrot; Hurtado, Yudy Clemencia Pinzon; Borges, Luís Henrique Barbosa

doi:10.1111/j.1346-8138.2000.tb02129.x

Cited by 17 publications

(14 citation statements)

References 41 publications

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“…The most common cutaneous manifestations of CMV infection in immunocompromized patients are transient macular rashes, morbilliform pruritic eruptions, and perioroanogenital ulcers 7 . The symptoms or signs of cutaneous CMV infection are not distinctive enough; however, only with the help of prompt histological examinations can we make a rapid diagnosis 8 .…”

Section: Discussionmentioning

confidence: 99%

Disseminated cytomegalovirus infection involving the skin in a patient with chronic renal insufficiency

et al. 2005

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A 58-year-old male with chronic renal insufficiency, gouty arthritis and iron deficiency anemia of 10 years' duration was admitted to our hospital because of pneumonia. He was treated with amoxicillin-clavulanate and gentamicin. He also received a transfusion of 2 units of packed red blood cells because of anaemia (hemoglobin 7.7 g /dl). Skin rashes appeared on the tenth day after admission, starting from his lower limbs with progressive, upward extension. Visual inspection revealed scaly erythematous macules and papules over his buttocks and lower limbs ( Fig. 1).A skin biopsy was performed from the patient's left thigh. The histopathological examination revealed moderate upper dermal perivascular mononuclear cell infiltrates. The main finding was enlarged endothelial cells containing darkly stained intranuclear inclusions (owl's eyes) characteristic of cytomegalovirus (CMV) infection ( Fig. 2a). PAS staining revealed intracytoplasmic inclusions (Fig. 2b).Laboratory surveys for systemic involvement were carried out. Serum titers of CMV antibodies showed IgG 250 AU/ml (normal range 0 -15) and IgM 1.513 (a normal range of the index < 0.5). Blood culture failed to isolate CMV whereas urine culture revealed a positive finding. Throat culture disclosed an adenoviral infection. Using two primer sets from the immediate-early gene, the results of polymerase chain reaction (PCR) with serum, urine and paraffin block of skin specimen all detected specific CMV DNA amplicons (Fig. 3). 1 The sequences of the primers for PCR detection of CMV are revealed in Table 1. These data indicated its disseminated nature instead of a localized cutaneous CMV infection.Immunological profiles showed normal IgG, IgA, and IgE values, while IgM and C3 levels were decreased (IgM 53 mg / dl and C3 62 mg /dl). Test for antinuclear factor was negative. The CD4 /CD8 ratio was decreased. In our case CD4 /CD8 ratio was 0.57, and the normal ratio of CD4 /CD8 ranges from 0.95 to 1.53. HIV antibody was negative. Figure 1 Multiple scaly erythematous macules and papules distributed on the left lower limb

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Section: Discussionmentioning

confidence: 99%

Disseminated cytomegalovirus infection involving the skin in a patient with chronic renal insufficiency

et al. 2005

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“…It has been repoted that serious CMV disease is mostly associated with deep cell immunosuppression (9–11). Diseases that compromise the immune system that may be associated with CMV disease include: systemic lupus erythematosus (12–14), mixed connective tissue disease (15), AIDS (16–18), burns (19) and septicemia (20). CMV disease may also occur in organ recipients of bone marrow, kidney, heart, lung and liver transplants (2, 5), either by transmission of the disease from the donor or after the immunosuppressive treatment for the transplant.…”

Section: Discussionmentioning

confidence: 99%

Disseminated Cytomegalovirus Disease as a Cause of Prolonged Fever in a Bullous Pemphigoid Patient under Systemic Steroid Therapy

Casals

Nunes

Maruta

et al. 2003

The Journal of Dermatology

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We present the first reported case of disseminated cytomegalovirus (CMV) in association with prednisone therapy in bullous pemphigoid (BP). A 66-year-old black male patient was admitted to our hospital presenting cutaneous pruritic lesions represented by tense blisters, with serous content on the arms, abdomen and legs. Laboratory findings confirmed the diagnosis of BP. After two weeks of prednisone therapy, the patient developed prolonged fever, which was caused by CMV disseminated disease, with prompt clinical recovery after ganciclovir administration.

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“…CMV may present with an ulcerated perianal lesion rather than a proctocolitis in patients with HIV and AIDS [36]. Other rare causes of anorectal ulceration in patients with HIV/AIDS include histoplasmosis, tuberculosis (including atypical forms), and amoebiasis [37].…”

Section: Rare Ulcerating Conditionsmentioning

confidence: 99%

Anorectal manifestations of sexually transmitted infections

Schofield¹,

Winceslaus²

2001

Colorect Dis

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Sexually transmitted infections have a wide range of clinical presentations, including involvement of the anal verge, anal canal and rectum. This review focuses on anorectal sexually transmitted infections which may cause diagnostic difficulty when encountered by the coloproctologist. An approach to the diagnosis of a variety of sexually transmitted infections is set out, with a discussion of the role of biopsy and a summary of relevant histopathological findings. The value of early antibiotic treatment is discussed. Problems related to HIV/AIDS are highlighted, as clinical presentation may be atypical in immunosuppressed individuals. Sexually transmitted oncogenic viruses and their role in anal neoplasia are also briefly summarized.

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Perianal Cytomegalovirus Ulcer in an HIV Infected Patient: Case Report and Review of Literature

Cited by 17 publications

References 41 publications

Disseminated cytomegalovirus infection involving the skin in a patient with chronic renal insufficiency

Disseminated cytomegalovirus infection involving the skin in a patient with chronic renal insufficiency

Disseminated Cytomegalovirus Disease as a Cause of Prolonged Fever in a Bullous Pemphigoid Patient under Systemic Steroid Therapy

Anorectal manifestations of sexually transmitted infections

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