Cytomegalovirus-Positive Mucosal Ulceration Mimics Recurrent Carcinoma in Oral Cavity-A Case Report

Cytomegalovirus (CMV) is a common latent virus. When the immune system shuts down, the virus can reactivate and attack organs such as the liver, lung, and digestive tract. Misdiagnosis and delayed treatment can cause lethal complications. We observed a 77-year-old male patient with a history of oral cancer and a CMV-positive mucosal ulcer that mimicked carcinoma recurrence. The biopsy indicated chronic inflammation without the presence of malignant cells. Despite dexamethasone ointment application for 2 weeks, the mucosal ulcer persisted. For a definitive diagnosis, the lesion was excised. Pathology indicated that the ulceration was associated with reparative atypical stromal cells without evidence of invasive carcinoma, which was confirmed by a cytokeratin AE1/AE3 stain. In immunohistochemistry, CMV inclusion bodies were detected in the foci. The histological CMV infection was then confirmed. A blood test for low avidity of CMV immunoglobulin M combined with a test for high avidity of CMV immunoglobulin G revealed the reactivation of CMV. The ulcer shrunk after a 3-week valganciclovir treatment. Although CMV-positive mucosal ulcers in the oral cavity are extremely rare, high awareness and effective examinations of blood tests and histopathology are crucial for effectively detecting and diagnosing CMV.

關鍵字

Cytomegalovirus ； Mucosal ulcer ； Immunohistochemistry ； Valganciclovir

並列摘要

巨細胞病毒是一種常見於人體中的潛伏型病毒，當宿主的免疫系統低落時，病毒將可能再度活化並攻擊人體器官，例如肝、肺或是消化系統等等，若病人被誤診或延誤治療將可能發生致死性的併發症。本文提出一位七十七歲男性罹患巨細胞病毒陽性之口腔黏膜潰瘍，因為此病患曾經患有口腔癌病史，此次黏膜潰瘍與癌症復發極為相似。初次切片報告指出，此病灶呈現慢性發炎反應，並沒有惡性細胞，然而在使用地塞松藥物塗抹治療兩周後，潰瘍並沒有消失，同時卻發生念珠菌伺機性感染，因此開始使用耐斯菌素漱口，一天四次，每次四萬單位。在使用一周後，念珠菌感染改善，但是潰瘍仍然持續。為了確立正確診斷，我們將此病灶完整切除。病理報告指出，此潰瘍可以觀察到修復性的非典型基質細胞，使用細胞角質蛋白AE1/AE3染色後並未看到惡性細胞；在免疫組織化學染色下，觀察到在細胞中的巨細胞病毒包涵體，於是證實了巨細胞病毒感染。血液檢測到親和力低的巨細胞病毒免疫球蛋白M合併親和力高的巨細胞病毒免疫球蛋白G，推測巨細胞病毒再活化感染。在使用纈更昔洛韋治療三周後，病灶縮小改善。儘管巨細胞病毒陽性之黏膜潰瘍極罕見於口腔中，不過保持高度警覺性、有效的血液學以及病理學檢查是確立正確診斷的基石。

並列關鍵字

巨細胞病毒；口腔潰瘍；免疫組織化學染色；纈更昔洛韋

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