case_images: PMC7542526_01
case_images: 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.
case_images: CRID2020-8843816.001.jpg
case_images: PMC7542526_01_CRID2020-8843816.001.jpg
case_images: fig1
case_images: Moreover, erosion was observed on the left side of the tongue (Figure 1).
case_images: 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.
case_images: CRID2020-8843816.002.jpg
case_images: PMC7542526_01_CRID2020-8843816.002.jpg
case_images: fig2
case_images: 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).
case_images: Findings from immunohistochemical staining of the specimen obtained from ulcer biopsy. Anticytomegalovirus antibodies are detected in the nuclei of infected cells. Bar: 40 mum.
case_images: CRID2020-8843816.003.jpg
case_images: PMC7542526_01_CRID2020-8843816.003.jpg
case_images: fig3
case_images: 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).
case_images: 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.
case_images: CRID2020-8843816.004.jpg
case_images: PMC7542526_01_CRID2020-8843816.004.jpg
case_images: fig4
case_images: 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.
case_images: 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.
case_images: CRID2020-8843816.005.jpg
case_images: PMC7542526_01_CRID2020-8843816.005.jpg
case_images: fig5
case_images: 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.