Cytomegalovirus (CMV) is an opportunistic pathogen in immunocompromised patients, especially in human immunodeficiency virus (HIV) and solid-organ transplant patients. Cases have also been described in patients with collagen vascular disease or lymphoma and patients on chronic corticosteroids.

Involvement of the oral cavity is rare, ulcers being the most frequent manifestation of CMV infection of the gastrointestinal tract. Infrequently, CMV can cause periodontitis, gingival hyperplasia, and sialadenitis in the oral cavity.

Patients often have concomitant infection of the gastrointestinal tract (bloody diarrhea) and/or the eyes (chorioretinitis). Other symptoms include lymphadenopathy, hepatosplenomegaly, esophagitis, pneumonia, and meningoencephalitis. Transmission is by body secretions, including saliva, blood, urine, breast milk, semen, and cervical fluid.

In one case report, an immunocompromised patient had an oral ulcer that was simultaneously infected by CMV, herpes simplex virus, and Epstein-Barr virus. The pathogenesis of coinfected ulcers is unknown, but it is thought that these human herpesviruses may potentiate each other.

With the advent of antiretroviral therapy (ART), this oral infection has been on the decline in the United States.

Related topic: Cytomegalovirus infection of newborn, Cytomegalovirus retinitis