Cytomegalovirus (CMV) is an extremely common viral infection and I occasionally encounter skin manifestations of this virus in my The Woodlands dermatology and Conroe dermatology offices. Although almost 80% of adults have been infected with CMV, only a few adults ever present with symptomatic CMV infection. The clinical signs and symptoms in adults are identical to infectious mononucleosis in EBV with a morbilliform or urticarial erupton, erythema nodosum, erythema multiforme, splenomegaly (enlarged spleen), fever, and pharyngitis (sore throat). Consuming synthetic penicillins while CMV infection is active can also cause the same morbilliform eruption that is seen in EBV. CMV infection can also be seen in newborns and is one of the causes of “blueberry muffin baby,” in which extramedullary hematopoiesis (blood cell line production in the dermis) produces purpuric nodular lesions. In immunosuppressed patients, CMV infection can become re-activated resulting in retinitis (inflammation of the retina), colitis (inflammation of the colon), and encephalitis (inflammation of the brain). A common skin finding in patients with AIDS and CMV infection are perianal ulcerations. Diagnosis is through culture and skin biopsy in which characteristic viral inclusions are observed on histology. Treatment of CMV usually necessitates the antivirals Foscarnet, Ganciclovir, or Cidofovir.
