An 86-year-old man with nonspecific interstitial pneumonia and poorly controlled diabetes mellitus came to our hospital with complaints of painful stomatitis and tongue ulcers lasting for 2 months (Fig. 1). He had been taking azathioprine at 50 mg/day and predonisolone, which was gradually tapered from 50 to 12.5 mg/day, for a period of 3 months.

Fig. 1
figure 1

Painful ulcers on dorsum and lateral edge of tongue

Full size image

The patient tested positive for cytomegalovirus (CMV) antigen (pp65) in 490 of 150,000 cells. A biopsy of the tongue ulcer showed enlarged endothelial cells with inclusion bodies. CMV immunofluorescent staining was positive, and herpes simplex staining was negative. The tongue ulcer improved rapidly following the initiation of ganciclovir treatment.

Oral lesions caused by CMV have been reported in transplantation recipients [1]. Human immunodeficiency virus patients are also known to suffer from oral ulcers caused by CMV [2]. However, there has been no report to date of a CMV-related oral ulcer that occurred during steroid or immunosuppressant treatment.

The involvement of CMV should be considered when patients who are prescribed steroid or immunosuppressant agents develop oral ulcers.