Cytomegalovirus infection initially diagnosed by skin biopsy

The reported cases of cutaneous involvement by cytomegalovirus (CMV) are mostly limited to descriptions in immunocompromised patients who had other evidence of systemic CMV infection or in patients whose disseminated infection was not diagnosed until autopsy. However, three cases of CMV infection initially diagnosed from antemortem biopsy of skin lesions have been documented in the literature. The authors review in depth one of these three cases and describe two new cases of CMV infection first identified by skin biopsy. The latter are the first detailed descriptions of this infection in the skin of burned patients. Review of the literature describing cutaneous CMV involvement reveals protean epidermal and dermal manifestations with consistent histologic findings. Recently, however, there has been documentation of histologically occult CMV in patients with disseminated CMV infection. Skin biopsy of cutaneous lesions in immunocompromised patients is important in the diagnosis of systemic CMV infection.