Atypical presentation of exophytic herpes simplex virus type 2 with concurrent cytomegalovirus infection: A significant pitfall in diagnosis

Academic Article


  • We report 3 unusual cases of atypical exophytic cutaneous herpes simplex virus (HSV) type 2 with concurrent cytomegalovirus (CMV) infection in immunosuppressed patients and raise awareness to the significant clinical and pathologic challenges in establishing the correct diagnosis. In all the 3 cases, the lesions presented as fungating plaques and nodules with areas of superficial erosion. Initial clinical differential included genital warts, syphilis, versus cutaneous malignancy. All the 3 patients were referred to the dermatology clinic where a combination of cutaneous biopsies, viral cultures of the lesions, polymerase chain reaction, CMV antigenemia, and immunoperoxidase stains for CMV and HSV confirmed the diagnosis of HSV type 2 with concurrent CMV infection. All the 3 patients were treated with oral valganciclovir with significant improvement noted at the follow-up visit. In addition, we review the previously reported HSV/CMV cutaneous coinfection cases. Copyright © 2013 by Lippincott Williams & Wilkins.
  • Published In

    Digital Object Identifier (doi)

    Author List

  • Garib G; Hughey LC; Elmets CA; Cafardi JA; Andea AA
  • Start Page

  • 371
  • End Page

  • 376
  • Volume

  • 35
  • Issue

  • 3