Oral mucosal cytomegalovirus as a manifestation of the acquired immune deficiency syndrome.

Cytomegalovirus (CMV) infection presenting as a painful palatal gingival ulcer was one of the initial clinical manifestations of the acquired immune deficiency syndrome (AIDS) in a male homosexual patient. The diagnosis of oral CMV infection was established when large intranuclear and smaller cytoplasmic CMV inclusions were observed in endothelial cells at the base of the mucosal ulcer. The identification of intranuclear and intracytoplasmic herpes-type viral particles in the infected cells was confirmed by electron microscopy. Cytoplasmic viral particles coexisted with paranuclear dense bodies resembling lysosomes. These features are characteristic of CMV-infected cells. A review of the English-language literature disclosed only three previously reported cases of CMV infection involving the oral mucous membranes. A vasculitis associated with the CMV-infected endothelial cells appears to be the underlying mechanism responsible for development of the oral ulcer. CMV should be considered a possible causative agent when oral ulcers are detected in immunocompromised patients. Likewise, the finding of CMV in oral ulcers should alert one to the possibility of an immunocompromised state.