Journal
AMERICAN JOURNAL OF DERMATOPATHOLOGY
Volume 35, Issue 3, Pages 371-376Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/DAD.0b013e3182539eee
Keywords
herpes simplex virus (HSV); cytomegalovirus (CMV); exophytic cutaneous lesion; exophytic cutaneous herpes simplex virus; fungating exophytic lesions; HSV with concurrent CMV infection; immunocompromised patients; immunosuppressed patients; HIV/AIDS
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Funding
- NIAMS NIH HHS [P30 AR050948] Funding Source: Medline
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We report 3 unusual cases of atypical exophytic cutaneous herpes simplex virus (HSV) type 2 with concurrent cytomegalovirus (CMV) infection in immunosuppressed patients and raise awareness to the significant clinical and pathologic challenges in establishing the correct diagnosis. In all the 3 cases, the lesions presented as fungating plaques and nodules with areas of superficial erosion. Initial clinical differential included genital warts, syphilis, versus cutaneous malignancy. All the 3 patients were referred to the dermatology clinic where a combination of cutaneous biopsies, viral cultures of the lesions, polymerase chain reaction, CMV antigenemia, and immunoperoxidase stains for CMV and HSV confirmed the diagnosis of HSV type 2 with concurrent CMV infection. All the 3 patients were treated with oral valganciclovir with significant improvement noted at the follow-up visit. In addition, we review the previously reported HSV/CMV cutaneous coinfection cases.
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