Research Article| Volume 64, ISSUE 2, P183-189, August 1987

Oral mucosal cytomegalovirus as a manifestation of the acquired immune deficiency syndrome

      This paper is only available as a PDF. To read, Please Download here.


      Cytomegalovirus (CMV) infection presenting as a painful palatal gingival ulcer was one of the initial clinical manifestations of the acquired immune deficiency syndrome (AIDS) in a male homosexual patient. The diagnosis of oral CMV infection was established when large intranuclear and smaller cytoplasmic CMV inclusions were observed in endothelial cells at the base of the mucosal ulcer. The identification of intranuclear and intracytoplasmic herpes-type viral particles in the infected cells was confirmed by electron microscopy. Cytoplasmic viral particles coexisted with paranuclear dense bodies resembling lysosomes. These features are characteristic of CMV-infected cells. A review of the Engish-language literature disclosed only three previously reported cases of CMV infection involving the oral mucous membranes. A vasculitis associated with the CMV-infected endothelial cells appears to be the underlying mechanism responsible for development of the oral ulcer. CMV should be considered a possible causative agent when oral ulcers are detected in immunocompromised patients. Likewise, the finding of CMV in oral ulcers should alert one to the possibility of an immunocompromised state.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


        • Nankervis GA
        • Kumar ML
        Diseases produced by cytomegalovirus.
        Med Clin North Am. 1978; 62: 1021-1035
        • Weller TH
        The cytomegalovirus: ubiquitous agents with protean clinical manifestations: part I and part II.
        N Engl J Med. 1971; 285: 203-214
        • Weller TH
        The cytomegalovirus: ubiquitous agents with protean clinical manifestations: part I and part II.
        N Engl J Med. 1971; 285: 267-274
        • Williams G
        • Stretton TB
        • Leonard JC
        Cytomegalic inclusion disease and Pneumocystis carinii infection in an adult.
        Lancet. 1960; 2: 951-955
        • Myerson D
        • Hackman RC
        • Nelson JA
        • Ward DC
        • McDougall JK
        Widespread evidence of histologically occult cytomegalovirus.
        Hum Pathol. 1984; 15: 430-439
        • Robson GS
        • Mackay IR
        Generalized cytomegalovirus infection in a patient with lupoid hepatitis.
        Aust Ann Med. 1969; 18: 147-150
        • Bhumbra MD
        • Nankervis GA
        Cytomegalovirus infection: overview and new development.
        Postgrad Med. 1983; 73: 63-69
        • Robbins SL
        • Cotran RS
        • Kumar V
        Pathologic basis of diseases.
        in: 3rd ed. WB Saunders Company, Philadelphia1984: 286-288
        • Drew WL
        • Mintz L
        • Miner RC
        • Sands M
        • Ketterer B
        Prevalence of CMV infection in homosexual men.
        J Infect Dis. 1981; 143: 188-192
        • Minars N
        • Silvermans JF
        • Escobar MR
        • Martinez AJ
        Fatal cytomegalic inclusion disease: associated skin manifestations in a renal transplant patient.
        Arch Dermatol. 1977; 113: 1569-1571
        • Curtis JL
        • Egbert BM
        Cutaneous cytomegalovirus: an unusual clinical manifestation of a common opportunistic pathogen.
        Hum Pathol. 1982; 13: 1138-1141
        • Walker JD
        • Chesney T
        Cytomegalovirus infection of the skin.
        Am J Dermatopathol. 1982; 4: 263-265
        • Feldman PS
        • Walker AN
        • Baker R
        Cutaneous lesions heralding disseminated CMV infection.
        J Am Acad Dermatol. 1982; 7: 545-548
        • Weigand DA
        • Burgdorf WH
        • Tarpay MM
        Vasculitis in cytomegalovirus infection.
        Arch Dermatol. 1980; 116: 1174-1176
        • Ching-Shen L
        • Penha PD
        • Krishnan MN
        • Zak FG
        Cytomegalic inclusion disease of the skin.
        Arch Dermatol. 1981; 117: 282-284
        • Farber S
        • Wolbach SB
        Intranuclear and cytoplasmic inclusions (protozoan-like bodies) in the salivary glands and other organs of infants.
        Am J Pathol. 1932; 8: 123-136
        • Reichert CM
        • O'Leary TJ
        • Levens DL
        • Simrell CR
        • Macher AM
        Autopsy pathology in the acquired immune deficiency syndrome.
        Am J Pathol. 1983; 112: 357-382
        • Welch K
        • Finkbeiner W
        • Alpers CE
        • et al.
        Autopsy findings in the acquired immune deficiency syndrome.
        JAMA. 1984; 252: 1152-1159
        • Guarda LA
        • Luna MA
        • Smith Jr, JL
        • Mansell PW
        • Gyorkey F
        • Roca AN
        Acquired immune deficiency syndrome: postmortem findings.
        Am J Clin Pathol. 1984; 81: 549-557
        • Smith TF
        • Holley KE
        • Keys TF
        • Macasaet FF
        Cytomegalovirus studies of autopsy tissue. I. Virus isolation.
        Am J Clin Pathol. 1975; 63: 854-858
        • Macasaet FF
        • Holley KE
        • Smith TF
        • Keys TF
        Cytomegalovirus studies of autopsy tissue. II. Incidence of inclusion bodies and related pathologic data.
        Am J Clin Pathol. 1975; 63: 859-865
        • Meiselman MS
        • Cello JP
        • Margaretten W
        Cytomegalovirus colitis: report of the clinical, endoscopic, and pathologic findings in two patients with AIDS.
        Gastroenterology. 1985; 88: 171-175
        • Levinson W
        • Bennett RW
        Cytomegalovirus colitis in AIDS: a chronic disease with varying manifestation.
        Am J Gastroenterol. 1985; 80: 445-447
        • Gertler SL
        • Pressman J
        • Price P
        • Brozinsky S
        • Katsumi M
        Gastrointestinal CMV infection in a homosexual man with severe AIDS.
        Gastroenterology. 1983; 85: 1403-1406
        • Goodman MD
        • Porter DD
        Cytomegalovirus vasculitis with fatal colonic hemorrhage.
        Arch Pathol. 1973; 96: 281-284
        • Siegal FP
        • Lopez C
        • Hammer GS
        • Brown AE
        • et al.
        Severe acquired immune deficiency syndrome in male homosexuals manifested by chronic perianal ulcerative herpes simplex lesions.
        N Engl J Med. 1981; 305: 1439-1444
        • Cohen SG
        • Greenberg MS
        Chronic oral herpes simplex virus infection in immunocompromised patients.
        Oral Surg Oral Med Oral Pathol. 1985; 59: 465-471
        • Barr RJ
        • Herten J
        • Grahm JH
        Rapid method for Tzanck preparation.
        JAMA. 1977; 337: 1119-1120
        • Blank H
        • Burgoon CF
        • Boldridge GD
        • McCarthy PL
        • Urback F
        Cytologic smears in diagnosis of herpes simplex, herpes zoster and varicella.
        JAMA. 1951; 146: 1410-1412
        • Meyers JD
        • Wade JC
        • McGuffin RW
        • Springmeyer SC
        • Thomas ED
        The use of acyclovir for CMV infections in the immunocompromised host.
        J Antimicrob Chemother. 1983; 12: 181-193
        • Balfour H
        • Bean B
        • Mitchell CD
        • Sachs GW
        • Boen JR
        • Edelman CK
        Acyclovir in immunocompromised patients with CMV disease: a controlled trial at one institution.
        Am J Med. 1982; 73: 241-248
        • Bean B
        Acyclovir in the treatment of herpesvirus infections.
        Postgrad Med. 1983; 73: 297-303
        • Fetterman GH
        A new laboratory aid in the clinical diagnosis of inclusion disease of infancy.
        Am J Clin Pathol. 1952; 22: 424-425
      1. Fields BN Knipe DM Chanock RM Melnick JL Roizman B Shope RE Virology. Raven Press, New York1985: 629-660
      2. Shiota H Cheng Y-C Prusoff WH Herpesvirus: clinical, pharmacological and basic aspects. ed. 10. International congress series 571. Excerpta Medica, Amsterdam1982: 8
        • Ruebner BH
        • Hirano T
        • Slusser R
        • Osborn J
        • Medearis Jr, DN
        Cytomegalovirus infection: viral ultrastructure with particular reference to the relationship of lysosomes and cytoplasmic inclusions.
        Am J Pathol. 1966; 48: 971-989
        • Mintz GA
        • Rose SL
        Diagnosis of oral herpes simplex virus infections: practical aspects of viral culture.
        Oral Surg Oral Med Oral Pathol. 1984; 58: 486-492
        • Gorelkin L
        • Chandler FW
        • Ewing EP
        Staining qualities of CMV inclusions in the lungs of patients with the acquired immune deficiency syndrome: a potential source of diagnostic misinterpretation.
        Hum Pathol. 1986; 17: 926-929
        • Stinski MF
        Human cytomegalovirus: glycoproteins associated with virions and dense bodies.
        J Virol. 1976; 19: 594-609