title: Atypical presentation of exophytic herpes simplex virus type 2 with concurrent cytomegalovirus infection: a significant pitfall in diagnosis.
abstract: 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.
authors.affiliation: Department of Pathology, Dermatopathology Section, University of Alabama at Birmingham, Birmingham, AL 35249, USA. ggarib@uab.edu
authors.forename: George
authors.initials: G
authors.lastname: Garib
authors.forename: Lauren C
authors.initials: LC
authors.lastname: Hughey
authors.forename: Craig A
authors.initials: CA
authors.lastname: Elmets
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Cafardi
authors.forename: Aleodor A
authors.initials: AA
authors.lastname: Andea
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D001706:Biopsy; D060085:Coinfection; D003586:Cytomegalovirus Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D003937:Diagnosis, Differential; D005260:Female; D006561:Herpes Simplex / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000821:virology; D018258:Herpesvirus 2, Human / Q000302:isolation & purification*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012867:Skin / Q000276:immunology / Q000473:pathology / Q000821:virology*; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents