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April 1990

Cutaneous Cytomegalovirus or Disseminated Verrucous Varicella Zoster

Author Affiliations

Department of Dermatology, 4M70 San Francisco General Hospital 1001 Potrero Ave San Francisco, CA 94110

Arch Dermatol. 1990;126(4):537-538. doi:10.1001/archderm.1990.01670280123026

To the Editor.—  We read with interest the recent article by Bournerias et al1 describing keratotic cutaneous lesions with a protracted course in patients with the acquired immunodeficiency syndrome. We have seen two patients at our institution with similar cutaneous lesions, and another has been reported (Fig 1).2,3 In both of our patients, and in the other patient who was described, however, varicella zoster virus was identified in the skin lesions by immunofluorescence and culture. All these patients had failed chronic oral acyclovir therapy for varicella zoster virus or herpes simplex virus infection. The varicella zoster virus isolates were acyclovir resistant due to thymidine kinase deficiency. It would be useful to know if in Dr Bournerias' cases there was a history of exposure to acyclovir or ganciclovir that might have selected for thymidine kinase-deficient mutants.The usual clinical appearance of cutaneous cytomegalovirus infection in acquired immunodeficiency syndrome is

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