Tongue Ulceration from Cytomegalovirus Infection
A 78-year-old man with end-stage renal disease, diabetes mellitus, and microscopic polyangiitis, for which he was taking glucocorticoids, presented to the rheumatology clinic with fever, painful glossitis, and taste abnormalities that had persisted for 1 month. Examination of the tongue showed a large, punched-out, painful ulcer. Biopsy of the lesion revealed numerous neutrophils, lymphocytes, plasma cells, and large cells with cytoplasmic inclusions. The findings were consistent with cytomegalovirus infection, and subsequent immunohistochemical stains for cytomegalovirus were positive, confirming the diagnosis. Cytomegalovirus infection can cause ulcerations in the intestine, stomach, and esophagus, but the tongue is less commonly involved. The patient was treated with ganciclovir, and the glucocorticoid dose was reduced. At the 6-week follow-up, the ulcer and its associated symptoms had resolved.
