摘要报道1例以皮肤损害为首要表现的巨细胞病毒(CMV)感染.患者女,46岁,因口周水疱、糜烂、痛3个月,左臂红斑、水疱、糜烂6周就诊.既往有系统性红斑狼疮、狼疮性肾炎病史12年,5个月前狼疮活动,予糖皮质激素及吗替麦考酚酯治疗.皮肤科检查:口周见不规则水疱,部分糜烂结痂;左前臂屈侧见一片状红斑,中央糜烂;左上臂见红斑水疱;腹部多发瘀点、瘀斑.皮损组织病理(左上臂):表皮松解坏死,内可见病毒包涵体样结构;免疫组化:表皮松解处大细胞内CMV抗原染色阳性.皮损分泌物CMVDNA阳性,血清CMV DNA初次检测阴性,1周后为8.04×103拷贝/ml;血清CMV IgG阳性.诊断:皮肤CMV感染.予口服更昔洛韦及外用后皮疹逐渐好转,但随后出现重症肺部感染,最终患者因多脏器功能衰竭死亡.

abstractsA case of cytomegalovirus infection with skin lesions as the primary manifestation is reported.A 46-year-old female patient presented with a 3-month history of painful perioral blisters and erosions,and a 6-week history of erythema,blisters and erosions on the left ann.The patient was ever diagnosed with systemic lupus erythematosus and lupus nephritis 12 years prior to the presentation.Systemic lupus erythematosus was exacerbated 5 months prior to this presentation,and glucocorticoids and mycophenolate mofetil were administered.Skin examination revealed irregularly shaped perioral blisters with erosions and crusts,localized patchy erythema with erosion in the center on the flexor aspect of the left forearm,erythema and blisters on the left upper arm,and multiple petechiae and ecchymoses on the abdomen.Histopathological examination of the skin lesion on the left upper limb showed epidermal necrolysis with scattered viral inclusion bodies.Immunohistochemical examination revealed positive staining for cytomegalovirus antigen in giant cells in the necrolytic epidermis.Cytomegalovirus DNA was detected in exudates from lesions.However,cytomegalovirus DNA was not detected in the serum in the initial test,but became positive (8.04 × 103 copies/ml) 1 week later.In addition,anti-cytomegalovirus IgG antibodies were detected in the serum.The patient was diagnosed with cutaneous cytomegalovirus infection.Affter the treatment with both oral and topical ganciclovir,the lesions were improved gradually,followed by severe pulmonary infection,and the patient was finally died of multiple organ failure.