Oral ulcers in heart transplant patient
The present case has been reported in the Indian Journal of Dermatology, Venereology and Leprology.

A 40-year-old man, with a history of heart transplantation two years back, presented with painful oral ulcers of three-weeks duration. Physical examination disclosed two large and deep, irregularly shaped ulcers on his lower lip and right buccal mucosa. No fever or other systemic symptoms were observed. His usual medications included mycophenolate mofetil 360 mg daily and tacrolimus 8 mg daily.

Culture specimens were negative for bacteria and herpes simplex virus type I and II. Blood cell counts only showed a mild leukopenia (3.23 × 109/L; normal value: 3.80–11.00 × 109/L) and neutropenia (1.17 × 109/L; normal value: 1.80–7.00 × 109/L); the rest of the analysis were normal.

Skin biopsy revealed a dense perivascular and mixed interstitial infiltrate composed of neutrophils, eosinophils, lymphocytes, and plasma cells. Endothelial cells demonstrated large eosinophilic inclusions, mostly intranuclear and occasionally intracytoplasmic, with some of them showing an “owl's eye” appearance.

Based upon histopathological appearance the lesions were diagnosed as Cytomegalovirus (CMV) oral ulcers.

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