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Case Reports in Infectious Diseases
Volume 2015, Article ID 723962, 4 pages
http://dx.doi.org/10.1155/2015/723962
Case Report

Cutaneous Ulcer as Leading Symptom of Systemic Cytomegalovirus Infection

1Department of Internal Medicine, Southern California Permanente Medical Group, Fontana, CA 92335, USA
2Department of Dermatology, Southern California Permanente Medical Group, Fontana, CA 92335, USA
3Department of Pathology, Southern California Permanente Medical Group, Fontana, CA 92335, USA
4Department of Rheumatology, Southern California Permanente Medical Group, Fontana, CA 92335, USA
5Department of Infectious Diseases, Southern California Permanente Medical Group, Fontana, CA 92335, USA

Received 23 July 2014; Accepted 30 January 2015

Academic Editor: Sinésio Talhari

Copyright © 2015 Richard F. Guo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Cytomegalovirus (CMV) infection rarely manifests with skin ulcerations. We describe a case report of a 64-year-old woman with chronic immunosuppression for treatment of mixed connective tissue disease, presenting with new onset leg ulcerations after a recent change in immunosuppressive regimen. She subsequently developed fulminant hepatitis, encephalopathy, and pancytopenia and was found to have severe systemic CMV viremia. Skin ulcer biopsy was positive by immunohistochemical staining for CMV infected endothelial cells. Both systemic disease and skin ulcer rapidly improved after stopping immunosuppression and administering intravenous ganciclovir. New onset skin ulcers in an immunosuppressed individual, especially with recent changes in immunosuppressive regimen, should raise the suspicion of reactivation of CMV.