SHM Converge Scientific Abstract ePoster Gallery-Cutaneous Cytomegalovirus as a Harbinger of Dissemination in Immunocompromised Patients

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This case describes a 32-year-old man with AIDS (CD4 count 45) who initially presented with a nonspecific rash, diarrhea, and later altered mental status. His rash was widespread, with hyperpigmented macules and eroded papulonodules on the face, trunk, and extremities. He was first admitted for presumed cellulitis, but a skin punch biopsy revealed cutaneous cytomegalovirus (CMV) infection.<br /><br />A few weeks later, the patient developed fatigue, headache, blurry vision, memory changes, dizziness, fevers, and acute worsening to encephalopathy. MRI showed multifocal leptomeningeal enhancement, and lumbar puncture demonstrated elevated protein and CMV DNA in the cerebrospinal fluid. He was diagnosed with disseminated CMV infection with CMV encephalitis.<br /><br />After treatment with intravenous ganciclovir, he had rapid improvement in diarrhea, visual symptoms, and mental status, with only a mild residual headache. The case highlights that cutaneous CMV, though rare, can be an early sign of disseminated disease in immunocompromised patients, preceding systemic organ involvement by weeks.<br /><br />Because the skin findings are nonspecific, biopsy is essential for diagnosis. The report emphasizes the need to consider CMV in the differential diagnosis of atypical skin lesions in patients with advanced HIV/AIDS or other immunocompromising conditions, and underscores the value of prompt multidisciplinary evaluation and early antiviral treatment.

Asset Subtitle

Katrina Guardino

Meta Tag

Author List Jenny Van Kirk, Katrina Guardino, River Jordan

Category Clinical Vignettes

Concept Skin Lesion

Concept Cytomegalovirus Infection

Concept Immunocompromised State

Concept HIV/AIDS

Concept Human immunodeficiency virus infection

Distinguished Non-Finalist

Presenter Organization Duke University School of Medicine

Presenting Author Katrina Guardino

Track Adult

Keywords

AIDS

cytomegalovirus

cutaneous CMV

CMV encephalitis

disseminated CMV

HIV

skin biopsy

immunocompromised

ganciclovir

leptomeningeal enhancement

Skin Lesion

Cytomegalovirus Infection

Immunocompromised State

HIV/AIDS

Human immunodeficiency virus infection