A 78-year-old man presented to the rheumatology clinic with a 1-month history of taste abnormalities, painful glossitis and fever. The patient also had a history of microscopic polyangitis, diabetes mellitus and renal disease, for which he was prescribed glucocorticoids.
Examination of the tongue revealed a large, painful ulcer. The tongue ulceration was biopsied; histopathological analysis of the lesion showed numerous large cells with cytoplasmic inclusions, plasma cells, lymphocytes and neutrophils.
The immunohistochemical stains for cytomegalovirus were positive and confirmed the diagnosis of cytomegalovirus infection.
Cytomegalovirus
Cytomegalovirus is a common virus that spreads from person to person via saliva, semen, blood, breast milk and urine. Once infected with the virus, it is retained in the body for life. It rarely causes problems in healthy people. However, is a cause of concern if the immune system is weakened. The infection can be fatal for people with bone marrow, stem cell or organ transplant. There is no cure for the infection, however, medication can help abate the symptoms. Cytomegalovirus commonly causes ulcerations in the esophagus, stomach and intestine, however, it is uncommon for it to involve the tongue.
Treatment was initiated with ganciclovir and the dose of glucocorticoid was reduced. The ulcer and its associated symptoms had resolved at the 6-week follow-up.
References
Nishioka, R., & Kawano, M. (2020). Tongue Ulceration from Cytomegalovirus Infection. The New England Journal of Medicine, 383(1), 67-67.
