Choi Y-L, Kim J-A, Jang K-T, Kim D-S, Kim W-S, Lee J-H, Yang J-M, Lee E-S, Lee D-Y
Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Gangnam-Gu, Seoul, Korea.
Br J Dermatol. 2006 Nov;155(5):977-82. doi: 10.1111/j.1365-2133.2006.07456.x.
Although cytomegalovirus (CMV) disease is a severe complication among immunocompromised patients, its cutaneous features have not been frequently reported. As herpes simple virus (HSV) infection commonly develops in CMV skin lesions, a study is needed on the pathogenetic role of CMV in cutaneous lesion formation.
The purpose of this study is to characterize the clinical and histopathological features of cutaneous CMV infection and to determine whether CMV plays a true pathogenetic role in cutaneous lesions, or if it is just an innocent bystander during HSV infection among non-AIDS (acquired immune deficiency syndrome), immunocompromised patients.
A total of nine human immunodeficiency virus-negative patients diagnosed with cutaneous CMV infection from July 1999 to February 2005 at Samsung Medical Center were analysed in terms of their clinical and histopathological characteristics. In addition, we examined for the co-presence of HSV by performing immunohistochemical analysis and polymerase chain reaction.
All the patients were immunocompromised; five had haematological diseases and four were organ transplant recipients. The clinical and histopathological features were similar to those of previous studies of patients with AIDS. Multiple anogenital ulcerations were the most frequent cutaneous presentation (66.7%). Most cytopathic changes were found in the dermis, particularly within the vascular endothelial cells (77.8%) and macrophages (66.7%). However, the association of CMV with concurrent HSV infection was even lower than that seen in patients with AIDS. Only one patient revealed a co-existing cutaneous HSV infection.
In non-AIDS individuals, the cutaneous lesions from CMV infection showed similar clinical and histopathological features to those of patients with AIDS. However, skin lesions may not be highly associated with HSV, and CMV does seem to contribute to lesion development as a cutaneous manifestation among the CMV infected, non-AIDS, immunocompromised patients.
尽管巨细胞病毒（CMV）疾病是免疫功能低下患者的一种严重并发症，但其皮肤表现却鲜有报道。由于单纯疱疹病毒（HSV）感染常发生于CMV皮肤病变中，因此有必要研究CMV在皮肤病变形成中的致病作用。
本研究旨在描述皮肤CMV感染的临床和组织病理学特征，并确定CMV在皮肤病变中是否发挥真正的致病作用，或者在非艾滋病（获得性免疫缺陷综合征）免疫功能低下患者的HSV感染过程中它是否只是一个无辜的旁观者。
对1999年7月至2005年2月在三星医疗中心诊断为皮肤CMV感染的9例人类免疫缺陷病毒阴性患者的临床和组织病理学特征进行了分析。此外，我们通过免疫组织化学分析和聚合酶链反应检测了HSV的共存情况。
所有患者均免疫功能低下；5例患有血液系统疾病，4例为器官移植受者。临床和组织病理学特征与先前对艾滋病患者的研究相似。多发性肛门生殖器溃疡是最常见的皮肤表现（66.7%）。大多数细胞病变变化见于真皮，特别是血管内皮细胞（77.8%）和巨噬细胞（66.7%）内。然而，CMV与并发HSV感染的关联甚至低于艾滋病患者。只有1例患者显示存在皮肤HSV合并感染。
在非艾滋病个体中，CMV感染引起的皮肤病变在临床和组织病理学特征上与艾滋病患者相似。然而，皮肤病变可能与HSV的相关性不高，并且CMV似乎确实作为CMV感染的非艾滋病免疫功能低下患者的一种皮肤表现促成了病变的发展。
