The skin biopsy demonstrated an amphophilic inclusion with I chromatin condensed at the nucleus perimeter, i.e., the classic cytomegalovirus (CMV) "inclusion body," with the use of a CMV-specific immunohistochemistry stain (CCH2/AD169; see Fig. ID in the photo quiz). Within the endothelial cells, there was also abundant eosinophilic cytoplasm with irregularities consistent with CMV viral cytopathic effect, and both nuclear and cyto-plasmic inclusions were visible (see Fig. IB and C, respectively, in the photo quiz). Bronchoalveolar lavage, colonic biopsy, and plasma PCR all confirmed the presence of CMV, with a plasma titer of 50,000 copies/ml. The patient's prednisone treatment was stopped, and intravenous ganciclovir treatment started; his cough and diarrhea began to resolve within 1 day. At the 1-month follow-up examination, the patient's CMV plasma titer was unde-tectable (<75 copies/ml), and his skin lesion was almost completely resolved. It is important to note that he continued receiving steroid treatment, even as an outpatient.
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