Finan Dominic, Garg Vaibhav, Lang Lucjan, Royer Tricia, Belden Katherine, Yang Sherry
Department of Dermatology & Cutaneous Biology, Thomas Jefferson University, Philadelphia, PA, USA.
Department of Infectious Diseases, Thomas Jefferson University, Philadelphia, PA, USA.
SAGE Open Med Case Rep. 2025 May 26;13:2050313X251341511. doi: 10.1177/2050313X251341511. eCollection 2025.
Cutaneous cytomegalovirus infection is a rare but serious complication in solid organ transplant recipients. We present a 47-year-old male kidney transplant recipient with a chronic, nonhealing right lower extremity ulcer. Initial biopsies revealed septic vasculopathy, leading to treatment with sodium thiosulfate and antibiotics for suspected calciphylaxis. Despite regular wound care, the ulcer continued to worsen. After completing 6 months of cytomegalovirus prophylaxis, surveillance viral levels remained undetectable, but the ulcer progressed considerably. Worsening severity prompted hospitalization, during which cytomegalovirus viremia was detected, and an ulcer biopsy confirmed cytomegalovirus inclusion bodies. Antiviral therapy was reinitiated, resulting in rapid and sustained wound improvement. Therefore, this case underscores cytomegalovirus' potential for cutaneous invasion in transplant recipients, even without preceding viremia, and highlights the importance of considering cutaneous cytomegalovirus in nonhealing ulcers posttransplant, especially in serodiscordant recipients.
皮肤巨细胞病毒感染在实体器官移植受者中是一种罕见但严重的并发症。我们报告一名47岁男性肾移植受者，其右下肢有一慢性不愈合溃疡。最初的活检显示为感染性血管病变，因怀疑钙化防御而接受硫代硫酸钠和抗生素治疗。尽管进行了常规伤口护理，溃疡仍持续恶化。在完成6个月的巨细胞病毒预防治疗后，监测病毒水平仍未检测到，但溃疡进展显著。病情恶化促使患者住院，住院期间检测到巨细胞病毒血症，溃疡活检证实有巨细胞病毒包涵体。重新开始抗病毒治疗后，伤口迅速且持续改善。因此，该病例强调了巨细胞病毒即使在无先前病毒血症的情况下也有侵袭移植受者皮肤的可能性，并突出了在移植后不愈合溃疡中考虑皮肤巨细胞病毒感染的重要性，尤其是在血清学不一致的受者中。
