Background: It is widely known that cytomegalovirus (CMV) primarily brings about subclinical and asymptomatic infection in the early stages of life and can cause various dermatological and systemic disorders under immunosuppressed conditions. Nonimmunosuppressed individuals very rarely present with cutaneous CMV involvement. Objective: In the present study, we described the clinical characteristics of 5 nonimmunosuppressed adult patients with positive IgM antibody to CMV. Methods: The systemic symptoms and dermatological features of these 5 patients were described. Laboratory examinations including blood cell counts, liver and renal functions were performed. IgG and IgM antibodies to CMV were also examined at the first consultation and 2–3 months after the skin eruption. Polymerase chain reaction for CMV DNA was performed in the skin samples of the patients. Results: All 5 patients had fever and complained of a sore throat. Multiple exudative erythema and target lesions with itching were observed mainly on the extremities. These symptoms and eruptions disappeared within 1 week after the onset and IgM antibody titers significantly decreased after 2–3 months. IgG antibody to CMV was already positive in 3 cases but was negative in 2 cases at the initial consultation. Con clusion: We propose that CMV infection may cause erythema multiforme by primary, recurrent infections or reactivation of CMV even in nonimmunosuppressed adults.

Keywords:
Erythema multiforme, Cytomegalovirus, Viral infection
1.
Bowers KE: Cytomegalovirus infection; in Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Katz SI, Fitzpatrick TB (eds): Dermatology in General Medicine, ed 5. New York, McGraw-Hill, 1999, pp 2450–2457.
2.
Drago F, Aragone MG, Lugani C, Rebora A: Cytomegalovirus infection in normal and immunocompromised humans. Dermatology 2000;200:189–195.
3.
Bhawan J, Gellis S, Ucci A, Chang T-W: Vesiculobullous lesions caused by cytomegalovirus infection in an immunocompromised adult. J Am Acad Dermatol 1984;11:743–747.
4.
Pariser RJ: Histologically specific skin lesions in disseminated cytomegalovirus infection. J Am Acad Dermatol 1983;9:937–946.
5.
Lee J Y-Y: Cytomegalovirus infection involving the skin in immunocompromised hosts. Am J Clin Pathol 1989;92:96–100.
6.
Spear JB, Kessler HA, Dworin A, Semel J: Erythema nodosum associated with acute cytomegalovirus mononucleosis in an adult. Arch Intern Med 1988;148:323–324.
7.
Sugiura H, Sawai T, Miyauchi H, Uehara M, Watanabe S, Okabe H, Ishizuka Y: Successful treatment of disseminated cutaneous cytomegalic inclusion disease associated with Hodgkin’s disease. J Am Acad Dermatol 1991;24:346–352.
8.
Sahud MA: Cytomegalovirus-induced thrombocytopenia. Arch Intern Med 1978;138:1573–1575.
9.
Bournérias I, Boisnic S, Patey O, Deny P, Gharakhanian S, Duflo B, Gentilini M: Unusual cutaneous cytomegalovirus involvement in patients with acquired immunodeficiency syndrome. Arch Dermatol 1989;125:1243–1246.
10.
Berant M, Naveh Y, Weissman I: Papular acrodermatitis with cytomegalovirus hepatitis. Arch Dis Child 1983;58:1024–1025.
11.
Lin C-S, Penha PD, Krishnan MN, Zak FG: Cytomegalic inclusion disease of the skin. Arch Dermatol 1981;117:282–284.
12.
Seishima M, Izumi T, Oyama Z: Rubella-like or morbilliform eruptions in non-immunosuppressed patients with positive IgM antibody to cytomegalovirus. Br J Dermatol 2001;144:203–204.
13.
Olive DM, Simsek M, Al-Mufti S: Polymerase chain reaction assay for detection of human cytomegalovirus. J Clin Microbiol 1989;27:1238–1242.
14.
Bastuji-Garin S, Rzany B, Stern RS, Shear NH, Naldi L, Roujeau J-C: Clinical classification of cases of toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme. Arch Dermatol 1993;129:92–96.
15.
Dowd PM, Champion RH: Erythema multiforme; in Champion RH, Burton JL, Burns DA, Breathnach SM (eds): Textbook of Dermatology, ed 6. Oxford, Blackwell Science, 1998, pp 2081–2085.
16.
Gordon AM, Lyell A: Mycoplasmas and their association with skin disease. Br J Dermatol 1970;82:414–417.
17.
Drago F, Romagnoli M, Loi A, Rebora A: Epstein-Barr virus-related persistent erythema multiforme in chronic fatigue syndrome. Arch Dermatol 1992;128:217–222.
18.
Strom J: Febrile mucocutaneous syndromes (ectodermosis erosiva pleuriorificialis, Stevens-Johnson syndrome etc) in adenovirus infections. Acta Derm Venereol (Stockh) 1967;47:281.
19.
Toome BK, Bowers KE, Scott GA: Diagnosis of cutaneous cytomegalovirus infection: A review and report of a case. J Am Acad Dermatol 1991;24:857–863.
20.
Golden MP, Hammer SM, Wanke CA, Albrecht MA: Cytomegalovirus vasculitis: Case reports and review of the literature. Medicine 1994;73:246–255.
21.
van Loon AM, Heessen FWA, van der Logt JTM: Antibody isotype response after human cytomegalovirus infection. J Virol Methods 1987;15:101–107.
© 2001 S. Karger AG, Basel
2001
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