Unusual presentation of cytomegalovirus and varicella-zoster virus infection in a patient with good's syndrome: A case report

Abstract

The co-infection of cutaneous cytomegalovirus (CMV) and varicella-zoster virus (VZV) is a rare occurrence, particularly in the context of Good's syndrome (GS). This report presents a unique case of a 56-year-old man with GS, characterized by a thymoma, who developed cutaneous CMV and VZV co-infections. We discuss the clinical characteristics, diagnostic process, and treatment of this uncommon manifestation. A 56-year-old man with a mediastinal mass identified as thymoma type A and pleural metastasis, presented with a three-week progressive, painful generalized skin lesions on his face, trunk, and extremities. Upon further examination, multiple extensive vesicles with reddened bases were distributed throughout all regions of his body, some exhibited hemorrhagic characteristics. The histopathologic assessment indicated a herpes virus infection and leukocytoclastic vasculitis. Additionally, Immunohistochemistry staining for CMV highlighted infected endothelial cells. The patient was diagnosed with disseminated cutaneous co-infection of CMV and VZV in the context of Good's syndrome. The patient responded well to a treatment regimen combining intravenous immunoglobulin (IVIG) and ganciclovir therapy, leading to the complete resolution of skin lesions. He was recommended prophylactic treatment and showed significant improvement upon follow-up, ultimately being discharged in a favorable clinical condition. By gaining a better understanding of this condition, healthcare professionals can improve their ability to recognize and treat Good's syndrome effectively. Early identification and effective treatment have a crucial role in enhancing the prognosis.