Version June 2024
| Virus | Comments |
| Cytomegalovirus | Uncommon, indicates strong immunosuppression. Mucocutaneous lesions are polymorphic: vesicles, necrotic lesions, oral or genital ulcerations. |
| Epstein-Barr virus | Responsible for oral hairy leukoplakia. Sign of a strong immunosuppression. |
| Herpes simplex | Frequent. Reactivation can occur in the days following the transplantation or years later. Sometimes unusual presentations: skin necrosis, ulceration, pseudo-tumoral vegetations. Primary infection via the graft is possible. Disseminated herpes simplex infection can be complicated by life-threatening hepatitis[1]. |
| Herpes zoster | Reactivation occurs in about 20% of the patients with a liver graft. Necrotic or hemorrhagic pustules that can be limited to a dermatome or have a generalized distribution. Should be considered as a life-threatening complication. Can trigger unexpected complications such as pancreatitis. Like generalized shingles, varicella is a dermatologic emergency given the risk of visceral dissemination: meningoencephalitis, fulminant pneumopathy, and diffuse intravascular coagulopathy. |
| Molluscum contagiosum | Due to a poxvirus infection. Multiple and often large lesions found on the scalp, beard, axillae, and groin. Biopsies are necessary to differentiate them from verrucae, sebaceous hyperplasia, and cryptococcosis. |
| Papillomavirus | Verrucea appear two to three years after the transplantation and continue to grow and multiply over the years. More than 80% of the recipients of a liver graft have verrucea vulgaris or genital warts five years after transplantation. They are particularly frequent in patients with a strong immunosuppression. Papillomavirus lesions in the anogenital region increase the risk of a squamous cell carcinoma by a factor of 100. In the context of transplantation, the specific types of papillomaviruses lose their tissue specificity. Papillomaviruses type 6 and 11 have been found in verrucae vulgaris. Conversion to sirolimus may be a useful strategy for recalcitrant cutaneous viral warts[2]. |
| Trichodysplasia spinulosa | Spiny follicular papules on the face, ears, extremities, and trunk. The condition is characterized by hyperkeratotic material in hair follicles due to trichodysplasia spinulosa-associated polyomavirus. Therapy consists of reducing immunosuppression, topical cidofovir or retinoids, oral valganciclovir or leflunomide[3]. |
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