Cytomegalovirus skin disease in a kidney transplant patient

Abstract

A 44-year-old man with a history of renal transplantation presented with right lower abdominal wall swelling, redness and pain. A bacterial abscess was drained, and he was discharged home with oral antibiotics. After failing to improve, he returned to the hospital, where he was briefly treated with intravenous antibiotics and discharged home again. The patient returned 5 days later, reporting worsening right groin swelling that extended into the ipsilateral scrotum. Imaging revealed a persistent fluid collection in the region, and he was taken for surgical debridement. Tissue immunochemistry and histopathological evaluation identified cytomegalovirus infection. Plasma quantitative PCR for cytomegalovirus demonstrated high viraemia. The patient was successfully treated with intravenous ganciclovir, followed by oral valganciclovir, with resolution of the skin changes. Persistent hydrocele with epididymitis on imaging suggests that this process may have been the source of the cutaneous cytomegalovirus infection.

Keywords: infectious diseases; pathology.

Figure 1

(A) H&E stain of tissue from debridement of groin wound. Cytopathic effect of cytomegalovirus (CMV) is demonstrated by a cell (centre of the image) with cytomegaly and a large, single intranuclear inclusion surrounded by a clear halo in the periphery. Prominent acute inflammation is also present. (B) Immunohistochemical staining for CMV. Positive cells are shown staining dark brown.