What Do Skin Lesions From Cytomegalovirus Look Like?

Cytomegalovirus, or CMV, is a common virus that most people carry quietly for life, and it rarely touches the skin. When it does, it most often shows up as stubborn open sores, though it can take many other forms.1PubMed. Cutaneous cytomegalovirus manifestations, diagnosis, and treatment: a review Because the skin can be the first visible sign that the virus is active elsewhere in the body, these sores are worth taking seriously.2PubMed. Cutaneous cytomegalovirus manifestations, diagnosis, and treatment: a review

The Most Typical Look Is a Slow-Healing Open Sore

The skin problem CMV causes most often is an ulcer, an open sore where the top layers of skin have broken down.3PubMed. Cutaneous cytomegalovirus manifestations, diagnosis, and treatment: a review Across reported cases, these sores sat most often around the anus or in the mouth.4PubMed. Cutaneous cytomegalovirus manifestations, diagnosis, and treatment: a review Day to day, a CMV ulcer looks like a shallow or punched-out raw area, often with red edges. It can hurt, especially when you sit, have a bowel movement, or eat. It may weep or crust over, then reopen, and it lasts weeks rather than days. Because CMV ulcers tend to persist, they often come to attention as sores that won’t heal despite usual treatment.5PubMed. Cutaneous cytomegalovirus and herpes simplex virus coinfection presented as refractory buttock ulcer in a patient with anti-interferon-γ syndrome

An ordinary cut or pressure sore usually has a clear cause and shows some progress within a week or two, such as shrinking edges or new pink skin. A CMV ulcer has no injury that explains it, and it doesn’t improve with creams or antibiotics. It may come with fever, tiredness, or other signs of illness. Many infections and skin diseases can produce a similar-looking ulcer, so the clue is a sore that won’t close, more than its exact shape.

CMV ulcers can also appear on the legs and face.6PubMed Central. Cutaneous Ulcer as Leading Symptom of Systemic Cytomegalovirus Infection A facial ulcer in a kidney transplant recipient turned out to be CMV and healed on antiviral medicine.7PubMed. A potential role for cytomegalovirus in a facial ulcer in a renal transplant recipient

If you have a weakened immune system, show any sore that lasts more than two weeks to a doctor. Take dated phone photos so the change over time is visible, and mention a transplant, HIV, or immune-suppressing drugs at the start of the visit.

Other Forms CMV Can Take on the Skin

Reported CMV skin changes cover a wide range:

The virus infects cells lining the small blood vessels in the skin. Damage to those vessels can show up as blood spots, purple patches, or breakdown into sores, and the body’s immune reaction adds redness and swelling.

In otherwise healthy adults who become very ill with CMV, a flat-and-raised red rash is the most common skin sign.15PubMed Central. The Wide Spectrum of Presentations of Cytomegalovirus Infection in Immunocompetent Hosts: An Exhaustive Narrative Review It appeared in roughly 7% to 20% of such patients across studies.16PubMed Central. The Wide Spectrum of Presentations of Cytomegalovirus Infection in Immunocompetent Hosts: An Exhaustive Narrative Review The rash often follows a course of the antibiotic ampicillin given before CMV was suspected.17PubMed Central. The Wide Spectrum of Presentations of Cytomegalovirus Infection in Immunocompetent Hosts: An Exhaustive Narrative Review Pinpoint blood spots or bruise-like purple patches from low platelets are rare.18PubMed Central. The Wide Spectrum of Presentations of Cytomegalovirus Infection in Immunocompetent Hosts: An Exhaustive Narrative Review Inflamed small blood vessels in the skin are seen more often than those blood spots.19PubMed Central. The Wide Spectrum of Presentations of Cytomegalovirus Infection in Immunocompetent Hosts: An Exhaustive Narrative Review In someone who is very ill, a rash after ampicillin may point to a viral illness such as CMV rather than a simple drug allergy, so it is worth asking whether CMV was tested.

Transplant patients show the variety well. In kidney transplant recipients, CMV skin disease has included tongue and anal ulcers, facial blood spots, and a lump on the ear.20PubMed. Cutaneous manifestations of cytomegalovirus disease in renal transplant recipients: a case series One transplant patient had a red, swollen, painful area on the lower belly wall.21PubMed Central. Cytomegalovirus skin disease in a kidney transplant patient

None of these forms is specific to CMV. Each is far more often caused by something else, such as a drug reaction, another viral illness, or an ordinary skin condition. What raises suspicion is the setting: a weakened immune system, a significant illness, or a rash that doesn’t follow the usual pattern or response to treatment. If a rash comes with fever, swollen glands, or marked tiredness, describe the whole picture to the doctor, because the combination guides testing more than the rash does.

Where on the Body CMV Lesions Appear

CMV can infect the bowel and be shed in stool, so it may seed the skin around the anus.22PubMed Central. Cytomegalovirus-induced cutaneous ulcers: A case series In people with HIV, CMV sores are often around the anus and genitals.23The Journal of Clinical and Aesthetic Dermatology. Cutaneous Co-infected Cytomegalovirus and Herpes Simplex Virus Perigenital Ulcers in Human Immunodeficiency Virus Patients

These sores are typically open sores or raw areas rather than clusters of small blisters, though the appearance varies and can overlap with other conditions. They may sit in skin folds, around the anus, on the groin or buttocks, or on the genitals, and can be painful or sting with moving and wiping. They can enlarge slowly over weeks and may be slow to heal even with good hygiene.

They are also often missed or delayed. People feel embarrassed to show anal or genital sores, and the sores are easily mistaken for hemorrhoids, fissures, or herpes. Speaking up early speeds diagnosis.

Mouth sores that may be CMV tend to be on the tongue or inner cheeks, and they are larger and longer-lasting than common canker sores. They can make eating painful, so tell the care team.

If your immunity is weakened, you can check the area gently with a mirror or ask a caregiver, especially if there is unexplained pain, bleeding, or discomfort when sitting. Any sore here that persists for more than a couple of weeks should be seen, even if it doesn’t hurt much. Write down when you first noticed it and what you have used on it, so the doctor can see what has already been tried.

Who Gets CMV Skin Lesions

After the first infection the virus rests in the body, and a healthy immune system keeps it in check without symptoms. Anti-rejection drugs, high-dose steroids, and advanced HIV reduce the immune cells that normally hold it back. When that control slips, the virus can multiply and damage tissue, including skin.

People on immune-suppressing treatment with stubborn chronic skin disease showed CMV reactivation more often than others (about 17% vs 6%).24PubMed. Immunocompromised Patients with Therapy-Refractory Chronic Skin Diseases Show Reactivation of Latent Epstein‒Barr Virus and Cytomegalovirus Infection Some of those skin problems improved once antiviral treatment began.25PubMed. Immunocompromised Patients with Therapy-Refractory Chronic Skin Diseases Show Reactivation of Latent Epstein‒Barr Virus and Cytomegalovirus Infection

Even among people at risk, CMV skin disease is uncommon.26The Journal of Clinical and Aesthetic Dermatology. Cutaneous Co-infected Cytomegalovirus and Herpes Simplex Virus Perigenital Ulcers in Human Immunodeficiency Virus Patients It has also been found inside other blistering skin diseases, where it was hard to tell apart from the original blisters.27PubMed Central. Cutaneous Cytomegalovirus Infection Presenting As Recalcitrant Bullous Pemphigoid Lesion

For transplant recipients, risk tends to be greatest in the first months, when immune-suppressing doses are highest. Many programs give preventive antiviral medicine for a period, but CMV can still appear during or after it. The risk can return later if the drugs are increased, for example to treat rejection. In a healthy adult, CMV skin sores are very unlikely; the usual exception is a rash during a severe CMV illness.

How Doctors Confirm It Is CMV

CMV skin lesions have no feature that sets them apart by eye.28PubMed Central. Cutaneous Cytomegalovirus Infection Presenting As Recalcitrant Bullous Pemphigoid Lesion So doctors take a biopsy, a small skin sample, usually under local numbing. Under the microscope, infected cells are swollen with a dark spot that resembles an owl’s eye.29Clinical Research in Dermatology Open Access. Atypical Cutaneous Cytomegalovirus (CMV) Infections in Non-AIDS Patients; a Report of 2 Cases These changes are seen mostly in cells lining blood vessels and in immune cells deep in the skin.30PubMed. Characteristics of cutaneous cytomegalovirus infection in non-acquired immune deficiency syndrome, immunocompromised patients The sample needs to reach deep enough, which is why a deeper punch may be taken. Special stains and a DNA test on the sample confirm the virus.31PubMed. Diagnosis and treatment of a case of cutaneous cytomegalovirus infection with a dramatic clinical presentation Blood tests for virus levels can support the diagnosis.32PubMed. A potential role for cytomegalovirus in a facial ulcer in a renal transplant recipient

The procedure itself is brief. You get a numbing injection, then a small round sample is removed, followed by one or two stitches or a bandage. Expect minor soreness afterward and results in several days to a week.

A very shallow scrape can miss the infected cells and return a falsely reassuring result. If the first sample is negative but the sore persists, a repeat can be considered rather than assuming the answer is no. Telling the lab or doctor that CMV is suspected lets them order the right stains and tests.

CMV is often found together with herpes simplex in genital or anal sores.33PubMed Central. Cutaneous Co-infected Cytomegalovirus and Herpes Simplex Virus Perigenital Ulcers in Human Immunodeficiency Virus Patients Many doctors think herpes is the main cause in such mixed sores.34PubMed Central. Cutaneous Co-infected Cytomegalovirus and Herpes Simplex Virus Perigenital Ulcers in Human Immunodeficiency Virus Patients Still, in one patient the sore healed only once CMV-specific medicine was given.35PubMed Central. Cutaneous Co-infected Cytomegalovirus and Herpes Simplex Virus Perigenital Ulcers in Human Immunodeficiency Virus Patients A sore not improving on herpes medicine is a reason to test for CMV.

When you get results, ask whether the sample was tested for CMV specifically, not just herpes, and whether blood virus levels were checked. Ask what the plan is if the sore doesn’t improve.

What CMV Looks Like on a Newborn’s Skin

A baby infected before birth may have dark red to purple bumps and lumps all over the body from birth, often called blueberry muffin rash.36PubMed Central. Blueberry Muffin Baby with Cytomegalovirus Hepatitis The spots don’t fade when pressed, unlike many ordinary newborn rashes.37PubMed Central. Blueberry Muffin Baby with Cytomegalovirus Hepatitis In one baby this came with small birth size and liver inflammation.38PubMed Central. Blueberry Muffin Baby with Cytomegalovirus Hepatitis These spots are patches of blood-forming cells in the skin or small bleeds, so they are not unique to CMV.

To check whether spots fade, press a clear glass on the spot. If it stays visible through the glass, report it the same day.

Spots present at birth need prompt pediatric evaluation. CMV is tested from the baby’s urine or saliva early in life, and hearing checks matter because CMV can affect hearing.

Is It Serious and Does It Heal

CMV skin lesions can signal virus spreading inside the body and a more serious outlook.39PubMed. Cutaneous cytomegalovirus manifestations, diagnosis, and treatment: a review In one transplant patient, a facial sore came with trouble in the transplanted kidney.40PubMed. A potential role for cytomegalovirus in a facial ulcer in a renal transplant recipient Since the skin can show active virus before other symptoms, doctors often use a skin finding as a reason to check blood levels and other organs, which may include the eyes, lungs, bowel, and transplanted organ depending on symptoms. This wider look is precautionary and often finds that the disease is limited.

Antiviral drugs such as ganciclovir or valganciclovir are the main treatment. In one patient, leg ulcers improved rapidly within days of starting ganciclovir.41PubMed Central. Cutaneous Ulcer as Leading Symptom of Systemic Cytomegalovirus Infection

Treatment can be IV medicine in the hospital or tablets at home, with regular blood tests to watch blood counts and kidneys. Doctors may lower immune-suppressing drugs when that is safe, and wound care for the sore continues.

Some sores begin to improve within days to a couple of weeks, but a deep ulcer can take longer to heal. Treatment commonly continues for weeks and may be followed by a lower-dose preventive course while immunity stays low. A sore that fails to improve after a reasonable course should prompt the doctor to recheck the diagnosis or look for a drug-resistant virus or another infection.

Contact the care team quickly for fever, diarrhea, vision changes, breathing trouble, confusion, or unusual tiredness, or if new sores appear while on treatment.