Characteristics of cutaneous cytomegalovirus infection in non-acquired immune deficiency syndrome, immunocompromised patients

BACKGROUND: Although cytomegalovirus (CMV) disease is a severe complication among immunocompromised patients, its cutaneous features have not been frequently reported. As herpes simple virus (HSV) infection commonly develops in CMV skin lesions, a study is needed on the pathogenetic role of CMV in cutaneous lesion formation. OBJECTIVES: The purpose of this study is to characterize the clinical and histopathological features of cutaneous CMV infection and to determine whether CMV plays a true pathogenetic role in cutaneous lesions, or if it is just an innocent bystander during HSV infection among non-AIDS (acquired immune deficiency syndrome), immunocompromised patients. PATIENTS AND METHODS: A total of nine human immunodeficiency virus-negative patients diagnosed with cutaneous CMV infection from July 1999 to February 2005 at Samsung Medical Center were analysed in terms of their clinical and histopathological characteristics. In addition, we examined for the co-presence of HSV by performing immunohistochemical analysis and polymerase chain reaction. RESULTS: All the patients were immunocompromised; five had haematological diseases and four were organ transplant recipients. The clinical and histopathological features were similar to those of previous studies of patients with AIDS. Multiple anogenital ulcerations were the most frequent cutaneous presentation (66.7%). Most cytopathic changes were found in the dermis, particularly within the vascular endothelial cells (77.8%) and macrophages (66.7%). However, the association of CMV with concurrent HSV infection was even lower than that seen in patients with AIDS. Only one patient revealed a co-existing cutaneous HSV infection. CONCLUSIONS: In non-AIDS individuals, the cutaneous lesions from CMV infection showed similar clinical and histopathological features to those of patients with AIDS. However, skin lesions may not be highly associated with HSV, and CMV does seem to contribute to lesion development as a cutaneous manifestation among the CMV infected, non-AIDS, immunocompromised patients.