Ramdial Pratistadevi K, Dlova Ncoza Cordelia, Sydney Clive
Department of Anatomical Pathology, Nelson R Mandela School of Medicine and King Edward VIII Hospital, Private Bag 7, Congella, 4013, Kwazulu Natal, South Africa.
J Cutan Pathol. 2002 Aug;29(7):439-44. doi: 10.1034/j.1600-0560.2002.290709.x.
Although a range of cytomegalovirus (CMV)-induced cutaneous manifestations is described in AIDS patients, skin involvement in immunocompromised patients is rare, and intraneural CMV inclusions or CMV neuritis has not been documented in skin biopsies.
Cutaneous biopsies of CMV lesions were collected prospectively for 12 months. The morphology, sites and symptomatology of the individual lesions, associated systemic illnesses, treatment schedules and disease outcome were recorded. A total of nine biopsies were obtained from three females who presented with extensive painful perineal ulceration and disseminated cutaneous ulcers, nodules and plaques. Clinically, herpes simplex virus (HSV) ulceration was diagnosed and treatment with acyclovir was initiated after biopsies from the natal cleft, perineum and neck were obtained. All were superficial and demonstrated HSV infection. Only the natal cleft biopsy demonstrated coexistent CMV inclusions. Suboptimal healing necessitated two further biopsies from each patient, none of which demonstrated HSV inclusions. Three of four deep perineal biopsies demonstrated CMV inclusions within nerves attended by a lymphocytic infiltrate and architectural disturbances. Two deep cutaneous biopsies of the trunk and abdominal wall confirmed CMV in extraneural locations only. One superficial perineal biopsy did not demonstrate any viral inclusion.
In documenting CMV neuritis in painful perineal ulcers, the histopathological spectrum of perineal CMV ulcers is expanded, a cutaneous neurotropic characteristic of CMV is presented and a direct role for CMV in the pathogenesis of pain is suggested. CMV latency within perineal nerves is also revisited as another potential site of CMV reactivation in immunocompromised patients, and another potential site for possible venereal transmission of CMV infection. The exclusive presence of HSV in initial superficial biopsies highlights the need for optimally biopsied tissue to confirm the coexistence of CMV infection.
尽管在艾滋病患者中描述了一系列巨细胞病毒（CMV）引起的皮肤表现，但免疫功能低下患者的皮肤受累情况罕见，且皮肤活检中尚未记录到神经内CMV包涵体或CMV神经炎。
前瞻性收集CMV病变的皮肤活检样本，为期12个月。记录各个病变的形态、部位和症状、相关的全身性疾病、治疗方案和疾病转归。共从三名女性患者获得了九份活检样本，这些患者出现广泛的疼痛性会阴溃疡以及播散性皮肤溃疡、结节和斑块。临床上，诊断为单纯疱疹病毒（HSV）溃疡，并在从臀裂、会阴和颈部获取活检样本后开始用阿昔洛韦进行治疗。所有样本均为浅表性，显示HSV感染。只有臀裂活检样本显示存在CMV包涵体。愈合不佳需要对每位患者再进行两次活检，这些活检均未显示HSV包涵体。四份深部会阴活检样本中有三份显示神经内存在CMV包涵体，伴有淋巴细胞浸润和结构紊乱。两份躯干和腹壁的深部皮肤活检仅在神经外部位证实存在CMV。一份浅表会阴活检未显示任何病毒包涵体。
在记录疼痛性会阴溃疡中的CMV神经炎时，扩大了会阴CMV溃疡的组织病理学谱，呈现出CMV的皮肤嗜神经特性，并提示CMV在疼痛发病机制中起直接作用。会阴神经内的CMV潜伏也被重新审视，作为免疫功能低下患者中CMV再激活的另一个潜在部位，以及CMV感染可能通过性传播的另一个潜在部位。初始浅表活检中仅存在HSV突出了需要获取最佳活检组织以确认CMV感染并存的必要性。
Zotero 插件