PMC7542526_01
Oral findings in the patient at the initial visit. Ulcers are visible on the left buccal mucosa. Moreover, an erosion is seen on the tongue. Open arrow: cytomegalovirus-associated ulcer.
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Moreover, erosion was observed on the left side of the tongue (Figure 1).
Histopathological findings of the specimen obtained from the biopsy of the ulcer. The black box shows vascular endothelial cells containing enlarged nuclei with intranuclear inclusions (hematoxylin-eosin staining). Bar: 85 mum.
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Histopathological findings revealed a prominent ulcerative lesion containing numerous CMV-positive vascular endothelial cells scattered at the fundus of the ulcer (Figures 2 and 3).
Findings from immunohistochemical staining of the specimen obtained from ulcer biopsy. Anticytomegalovirus antibodies are detected in the nuclei of infected cells. Bar: 40 mum.
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fig3
Histopathological findings revealed a prominent ulcerative lesion containing numerous CMV-positive vascular endothelial cells scattered at the fundus of the ulcer (Figures 2 and 3).
Oral findings on day 9 after initiation of ganciclovir therapy. A persistent ulcer on the left buccal mucosa is visible, with reduced signs of inflammation. Open arrow: cytomegalovirus-associated ulcer.
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August 16, after the start of ganciclovir therapy on August 7, are shown in Figure 4. A persistent ulcer on the left buccal mucosa was noted, and the inflammation was less severe.
CRP and WBC levels and the administered medications during hospitalization are shown. CRP: C-reactive protein; WBC: leukocytes; GCV: ganciclovir; PCP: pneumocystis pneumonia; SMX: sulfamethoxazole-trimethoprim.
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fig5
C-reactive protein concentration and leukocyte count to 24.78 mg/dL and 89.4 x 102/mm3, respectively (Figure 5). Computed tomography images of the chest revealed the presence of ground-glass opacities, and noninvasive positive pressure ventilation was initiated under the provisional diagnosis of pneumocystis pneumonia caused by ganciclovir-associated myelosuppression and/or steroid-induced immunocompromised state.