HERPES-SIMPLEX AND CYTOMEGALOVIRUS COINFECTED ORAL ULCERS IN HIV-POSITIVE PATIENTS

Four HIV-positive patients with herpes simplex virus and cytomegalovir us coinfected oral ulcers are presented. All patients had persistent o ral pain associated with nonhealing mucosal ulcers. Lesions occurred o n the palate, retromolar pad, tongue, and lip, and the clinical appear ance of the ulcers was nonspecific. Histologic and immunohistochemical stains showed herpes simples virus alterations in keratinocyte nuclei and cytomegalovirus alterations in mesenchymal/endothelial cell nucle i and cytoplasm. Lesions in one patient responded to ganciclovir thera py. One patient improved with acyclovir, and another healed normally a fter excisional biopsy. Each virus alone has been described as causing oral ulcerations; their appearance together in the same lesion would suggest a synergistic relationship.