Cutaneous Cytomegalovirus Infection Presenting As Recalcitrant Bullous Pemphigoid Lesion

Abstract

Cytomegalovirus (CMV) infection is common among immunocompromised hosts; however, its cutaneous manifestation is considered rare in comparison to internal organ involvement. Clinical manifestations of cutaneous CMV infection generally include perioral or perianal ulcerations. On the other hand, autoimmune bullous dermatosis can have bullae and ulcerations similar to those caused by cutaneous CMV infection. Autoimmune bullous dermatosis requires treatment with immunosuppressive agents for relatively long periods, which may cause reduction of immunocompetence. Because of this iatrogenic immunosuppression, patients with autoimmune bullous dermatosis subsequently acquire increased risk for opportunistic infections. However, cases of bullous pemphigoid (BP) complicated by cutaneous CMV infection are rarely reported. Herein, we report the case of an 88-year-old male who had BP and subsequently recalcitrant perianal skin lesions, which were eventually diagnosed as cutaneous CMV infections.

Keywords: Bullous pemphigoid; Cytomegalovirus.

Fig. 1. (A) Remaining refractory ulcerations on the buttock after systemic treatment with immunosuppressors in a patient with bullous pemphigoid. (B) Improved ulcerations on the buttock after 1 week of systemic ganciclovir treatment, same patient.

Fig. 2. (A) A skin biopsy sample taken from ulceration on the buttock showed endothelial cells with large nuclei and basophilic intranuclear inclusions (H&E, ×400). (B) Immunohistochemistry for cytomegalovirus infection was positive, same biopsy sample (×400).