Abstract: 【Abstract】 A 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 arm. 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. After 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.

Key words: Cytomegalovirus infections, Lupus erythematosus, systemic, Immunocompromised host, Inclusion bodies, viral, Viral load