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Hartsough EM, Nazarian RM, Cornejo KM, Stagner AM. Unusual isolated cytomegalovirus cutaneous infections: A subtle histopathologic diagnosis with review of the literature. J Cutan Pathol 2024; 51:565-571. [PMID: 38654546 DOI: 10.1111/cup.14608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/28/2024] [Accepted: 02/28/2024] [Indexed: 04/26/2024]
Abstract
Cytomegalovirus (CMV) infection is common and often self-limited. Reactivation results in a variety of disease presentations, especially in the setting of immunocompromise. While cutaneous manifestations of systemic CMV infection are rare, dermatologic manifestations of CMV are increasingly reported with a wide morphologic spectrum clinically. Three male patients, with untreated human immunodeficiency virus (HIV), penile lichenoid dermatitis treated with long-term topical and intralesional corticosteroids, and metastatic Merkel cell carcinoma on immune checkpoint inhibitor therapy, each presented with isolated cutaneous ulcers. The ulcers were located on the perianal skin, glans of the penis, and distal thumb. In each case, nonspecific histopathologic features were seen. However, very rare dermal cytomegalic cells with nuclear and cytoplasmic inclusions were present and highlighted with an immunohistochemical stain for CMV. Isolated ulcers due to CMV infection may occur in the setting of systemic or localized immunosuppression. A high index of suspicion is needed upon histopathologic evaluation, as few cytomegalic cells may be present and accurate diagnosis is crucial for prompt and appropriate clinical management.
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Affiliation(s)
- Emily M Hartsough
- Dermatopathology Unit, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rosalynn M Nazarian
- Dermatopathology Unit, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristine M Cornejo
- Dermatopathology Unit, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna M Stagner
- Dermatopathology Unit, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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3
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Yokoyama A, Ito T, Furue M. Sudden and transient livedo reticularis as a manifestation of mononucleosis-like disease by cytomegalovirus. Clin Exp Dermatol 2021; 46:1158-1159. [PMID: 33740260 DOI: 10.1111/ced.14616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 11/26/2022]
Affiliation(s)
- A Yokoyama
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - T Ito
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - M Furue
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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4
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Hajihashemi Z, Bidari-Zerehpoosh F, Zahedi K, Eslami B, Mozafari N. Cytomegalovirus-induced cutaneous ulcer mimicking vasculitis in a patient with systemic lupus erythematous: A case report and review of the literature. Lupus 2020; 30:149-154. [PMID: 33012246 DOI: 10.1177/0961203320961473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease which can be complicated with cytomegalovirus (CMV) infection during its course. CMV reactivation can mimic an SLE flare and lead to delay in diagnosis. Here, we reported a previously diagnosed SLE patient who presented with fever, leukopenia, and cutaneous ulcers. Initially, this was diagnosed as an SLE flare and the patient was treated with higher doses of corticosteroids but no improvement was observed. Both nuclear and cytoplasmic inclusions inside the endothelial cells in the skin biopsy as well as positive immunohistochemistry (IHC) staining for CMV antigen were clues to the correct diagnosis of CMV reactivation. Treatment with ganciclovir resulted in clinical resolution. In this report, a very rare clinical form of CMV infection manifesting as cutaneous necrotizing vasculitis on the lower extremity is described and the literature regarding this case is reviewed.
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Affiliation(s)
- Zahra Hajihashemi
- Department of Rheumatology, Imam Hossein Teaching Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farahnaz Bidari-Zerehpoosh
- Department of Pathology, Loghman Teaching Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khatere Zahedi
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnaz Eslami
- Department of Infectious Disease, Imam Hossein Teaching Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nikoo Mozafari
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Elmas ÖF, Demirbaş A, Özyurt K, Atasoy M, Türsen Ü. Cutaneous manifestations of COVID-19: A review of the published literature. Dermatol Ther 2020; 33:e13696. [PMID: 32458546 PMCID: PMC7283644 DOI: 10.1111/dth.13696] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/23/2020] [Indexed: 12/20/2022]
Abstract
COVID-19 is a highly contagious respiratory tract infection caused by severe acute respiratory syndrome coronavirus 2. COVID-19 outbreak, which caused thousands of deaths, has been declared a pandemic by the World Health Organization in March 2020. The infection has been reported to demonstrate different types of cutaneous manifestations including urticarial, maculopapular, papulovesicular, purpuric, livedoid, and thrombotic-ischemic lesions. Given the high mortality rate of the infection, timely and accurate identification of relevant cutaneous manifestations may play a key role in the early diagnosis and management. In this study, we provide a review with a focus on the reported cutaneous manifestations of COVID-19.
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Affiliation(s)
- Ömer Faruk Elmas
- Department of Dermatology, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Abdullah Demirbaş
- Department of Dermatology, Konya Numune State Hospital, Konya, Turkey
| | - Kemal Özyurt
- Department of Dermatology, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Mustafa Atasoy
- Department of Dermatology, Health Science University, Kayseri City Hospital, Kayseri, Turkey
| | - Ümit Türsen
- Department of Dermatology, Mersin University, Mersin, Turkey
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6
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Abadeer K, Aslam N, Cortese C, Wadei HM. Cytomegalovirus-Induced Polyarteritis Nodosa in a Liver Transplant Recipient. Am J Transplant 2017; 17:3236-3240. [PMID: 28556523 DOI: 10.1111/ajt.14376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 04/21/2017] [Accepted: 05/11/2017] [Indexed: 01/25/2023]
Abstract
Polyarteritis nodosa (PAN) is a necrotizing vasculitis that has been associated with viral infections, especially hepatitis B virus. We hereby report a case of tissue-invasive cytomegalovirus (CMV)-induced PAN in a liver transplant recipient presenting with acute kidney injury and active urinary sediment. Treatment directed against both PAN and CMV resulted in improvement in kidney function, normalization of urinary indices and resolution of the CMV infection. There was no recurrence of either PAN or CMV after a 3-year follow-up period.
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Affiliation(s)
- K Abadeer
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL
| | - N Aslam
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL
| | - C Cortese
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL
| | - H M Wadei
- Department of Transplant, Mayo Clinic, Jacksonville, FL
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7
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Russell JNH, Marsh AK, Willer DO, Ambagala APN, Dzamba M, Chan JK, Pilon R, Fournier J, Brudno M, Antony JM, Sandstrom P, Evans BJ, MacDonald KS. A novel strain of cynomolgus macaque cytomegalovirus: implications for host-virus co-evolution. BMC Genomics 2016; 17:277. [PMID: 27044312 PMCID: PMC4820910 DOI: 10.1186/s12864-016-2588-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 03/14/2016] [Indexed: 12/20/2022] Open
Abstract
Background Cytomegaloviruses belong to a large, ancient, genus of DNA viruses comprised of a wide array of species-specific strains that occur in diverse array of hosts. Methods In this study we sequenced the ~217 Kb genome of a cytomegalovirus isolated from a Mauritius cynomolgus macaque, CyCMV Mauritius, and compared it to previously sequenced cytomegaloviruses from a cynomolgus macaque of Filipino origin (CyCMV Ottawa) and two from Indian rhesus macaques (RhCMV 180.92 and RhCMV 68–1). Results Though more closely related to CyCMV Ottawa, CyCMV Mauritius is less genetically distant from both RhCMV strains than is CyCMV Ottawa. Several individual genes, including homologues of CMV genes RL11B, UL123, UL83b, UL84 and a homologue of mammalian COX-2, show a closer relationship between homologues of CyCMV Mauritius and the RhCMVs than between homologues of CyCMV Mauritius and CyCMV Ottawa. A broader phylogenetic analysis of 12 CMV strains from eight species recovers evolutionary relationships among viral strains that mirror those amongst the host species, further demonstrating co-evolution of host and virus. Conclusions Phylogenetic analyses of rhesus and cynomolgus macaque CMV genome sequences demonstrate co-speciation of the virus and host. Electronic supplementary material The online version of this article (doi:10.1186/s12864-016-2588-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Angie K Marsh
- Department of Immunology, University of Toronto, Toronto, M5S 1A8, ON, Canada
| | - David O Willer
- Department of Medicine, University of Toronto, Toronto, M5S 1A8, ON, Canada.,Department of Microbiology, Mount Sinai Hospital, Toronto, M5G 1X5, ON, Canada
| | - Aruna P N Ambagala
- Department of Medicine, University of Toronto, Toronto, M5S 1A8, ON, Canada.,Department of Microbiology, Mount Sinai Hospital, Toronto, M5G 1X5, ON, Canada.,Present Address: Canadian Science Centre for Human and Animal Health, National Centre for Foreign Animal Disease, 1015 Arlington Street, Winnipeg, R3E 3M4, MB, Canada
| | - Misko Dzamba
- Department of Computer Science, University of Toronto, Toronto, M5S 1A8, ON, Canada
| | - Jacqueline K Chan
- Department of Medicine, University of Toronto, Toronto, M5S 1A8, ON, Canada.,Department of Microbiology, Mount Sinai Hospital, Toronto, M5G 1X5, ON, Canada
| | - Richard Pilon
- National HIV & Retrovirology Laboratories, Public Health Agency of Canada, Ottawa, K1A 0K9, ON, Canada
| | - Jocelyn Fournier
- Scientific Services Division, Health Products & Food Branch, Health Canada, Ottawa, K1A 0L2, ON, Canada
| | - Michael Brudno
- Department of Computer Science, University of Toronto, Toronto, M5S 1A8, ON, Canada
| | - Joseph M Antony
- Department of Medicine, University of Toronto, Toronto, M5S 1A8, ON, Canada.,Department of Microbiology, Mount Sinai Hospital, Toronto, M5G 1X5, ON, Canada
| | - Paul Sandstrom
- National HIV & Retrovirology Laboratories, Public Health Agency of Canada, Ottawa, K1A 0K9, ON, Canada
| | - Ben J Evans
- Biology Department, McMaster University, Life Sciences Building, 1280 Main Street West, Hamilton, L8S 4K1, ON, Canada
| | - Kelly S MacDonald
- Department of Immunology, University of Toronto, Toronto, M5S 1A8, ON, Canada. .,Department of Medicine, University of Toronto, Toronto, M5S 1A8, ON, Canada. .,Department of Microbiology, Mount Sinai Hospital, Toronto, M5G 1X5, ON, Canada. .,Section of Infectious Diseases, Department of Internal Medicine, University of Manitoba, 745 Bannatyne Ave, Winnipeg, R3E 0J9, MB, Canada. .,Present Address: University of Manitoba, Basic Medical Sciences Building, Room 501, 745 Bannatyne Ave., Winnipeg, R3E 0J9, MB, Canada.
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