Herpes simplex virus and cytomegalovirus co‐infection presenting as exuberant genital ulcer in a woman infected with human immunodeficiency virus

Summary In patients infected with human immunodeficiency virus ( HIV ), genital herpes can result in severe and atypical clinical presentations, and can become resistant to aciclovir treatment. Rarely, these manifestations may represent concurrent herpes simplex virus ( HSV ) with other agents. We report a 41‐year‐old black woman with HIV who presented with extensive and painful ulceration of the genitalia. Histological examination of a biopsy sample was suggestive of herpetic infection, and intravenous aciclovir was started, but produced only partial improvement. PCR was performed on the biopsy sample, and both HSV and cytomegalovirus ( CMV ) DNA was detected. Oral valganciclovir was started with therapeutic success. CMV infection is common in patients infected with HIV , but its presence in mucocutaneous lesions is rarely reported. This case exemplifies the difficulties of diagnosis of genital ulcers in patients infected with HIV . The presence of exuberant and persistent HSV genital ulcers in patients with HIV should also raise suspicions of the presence of co‐infection with other organisms such as CMV .