EJD, vol. 29, n ◦ 5, September-October 2019 565 which was confirmed by polymerase chain reaction (PCR; 1,200 copy/mL). Two months later, the clinical examination of the eight- month-old boy was normal. Anti-CMV IgG were detected but anti-HSV and anti-VZV antibodies were not present, and PCR blood test for enterovirus was negative. The mother was CMV IgG seropositive but was negative before her pregnancy. No immune deficiency was found. The com- plete blood count was normal with no Howell-Jolly body. Lymphocyte immunophenotyping and testing for quan- titative immunoglobulin including total IgE, chemotaxis of polynuclear neutrophils, and complement compo- nent were normal. Natural IgG anti-A antibodies were negative. The diagnosis of KVE is mainly based on clinical history of AD and specific umbilicated erythematous vesicles. The culture and PCR leads to identification of the virus, most commonly HSV. It was thus unexpected in our case to detect CMV and not HSV as anticipated. To our knowledge, no previous case of KVE due to CMV has been reported [1, 2]. Although vesicles were positive for CMV based on both cul- ture and PCR, HSV- and other virus-related KVE could not be formally excluded since cutaneous PCR for these viruses was not performed. However, the absence of anti-HSV and anti-VZV IgG and the absence of enterovirus DNA in blood makes this hypothesis unlikely. A CMV primary infection should also be discussed as sug- gested by the presence of hard palate erosion [1]. However, KVE can also be associated with viremia and involvement of the lungs, liver, brain, gastrointestinal tract and mucosa [3]. Furthermore, based on the unaffected skin with regards to vesicles which involved only pre-existing sites of atopic dermatitis, a CMV superinfection of pre-existing AD seems more likely. Recently, Drozd et al. [1] analysed 53 cases of cutaneous CMV. Manifestations were polymorphous including mor- billiform rash, petechiae, purpura, plaques, vesicles, bullae, erosions, erythema, papules, oedema, vasculitis, and pus- tules. However, ulcers, mainly mucosal, were the most reported lesion. Systemic manifestations of CMV have been described including pneumonitis, gastrointestinal, retini- tis, hepatitis and aseptic meningitis [2]. It should be noted that our child presented with intestinal and pulmonary symptoms before the occurrence of cutaneous lesions in association with the presence of anti-CMV IgG. We can thus hypothesize a primary systemic CMV infection as sug- gested by the CMV seroconversion of his mother during pregnancy or soon after childbirth, followed by a delayed cutaneous infection. The transplacental transfer of maternal anti-CMV IgG to the child can indeed be excluded at eight months of age. Although valganciclovir or ganciclovir are mainly used in the literature to treat cutaneous CMV manifestations [1], acyclovir was successfully used in our experience. Acy- clovir is a guanosine-analogue with activity against a range of herpesviruses. It is particularly active against herpes sim- plex virus-1 and -2, but also has some activity against CMV [4, 5]. KVE should be added to the list of less common dermato- logical presentations of CMV infection. ■ Disclosure. Conflicts of interest: none. Acknowledgements: The authors thank Elisabeth Homassel for her technical assistance. 1 Dpt of Dermatology, University of Franche Comté EA3181, and University Hospital, Besanc ¸on, France 2 Dpt of Virology, University Hospital, Besanc ¸on, France 3 Dpt of Pediatrics, University Hospital, Besanc ¸on, France <francois.aubin@univ-fcomte.fr> Adrien MARESCHAL 1 Grégoire CHEVALIER 1 Quentin LEPILLER 2 Raphael ANXIONNAT 3 Dominique BLANC 1 Eve PUZENAT 1 Franc ¸ois AUBIN 1 1. Drozd B, Andriescu E, Suárez A, De la Garza Bravo MM. Cuta- neous cytomegalovirus manifestations, diagnosis, and treatment: a review. Dermatol Online J 2019; 25: 1. 2. Gandhi MK, Khanna R. Human cytomegalovirus: clinical aspects, immune regulation, and emerging treatments. Lancet Infect Dis 2004; 4: 725-38. 3. Kramer SC, Thomas CJ, Tyler WB, Elston DM. Kaposi’s varicel- liform eruption: a case report and review of the literature. Cutis 2004; 73: 115-22. 4. Tyms AS, Scamans EM, Naim HM. The in vitro activity of acyclovir and related compounds against cytomegalovirus infections. J Antimi- crob Chemother 1981; 8: 65-72. 5. McKeen JT, Tsapepas DS, Li H, Anamisis A, Martin ST. Acyclovir versus valganciclovir for preventing cytomegalovirus infec- tion in intermediate-risk liver transplant recipients. Prog Transplant 2015; 25: 39-44. doi:10.1684/ejd.2019.3630 Ultrasonography and Doppler in patients with psoriasis and psoriatic arthritis Psoriasis (Pso) is one of the most common dermatological inflammatory conditions, with an estimated prevalence of 2-3%. Pso is related to a form of spondyloarthritis called “psoriatic arthritis” (PsoA); PsoA prevalence in patients with psoriasis ranges from 5 to 42%, depending on the population studied [1-3]. This study was designed to establish an epidemiolog- ical and ultrasonographic profile using colour Doppler ultrasound in patients with psoriasis and/or subclinical and clinical psoriatic arthritis to determine the Kappa index among observers and the most frequent ultrasound findings. A case-control study was performed between Decem- ber 2015 and December 2016 involving 144 patients with Pso and/or PsoA and 24 controls (AAE: 89054418.8.0000.5078) (table 1). The vast majority (95.8%) of the patients in the case group were negative for rheumatoid factor; 90.3% of the group had a clinical picture of cutaneous psoriasis, which was a mild to severe condition, and 39.8% had a diagnosis of psoriatic arthritis. However, 77.8% of these patients showed signs of enthesitis on ultrasound examination according to the MASEI criteria and 65.3% had clinical signs of nail psoriasis, such as pitting, onycholysis, nail hyperkeratosis, etc. on any of the 20 fingers or toes. In the control group, signs of nail psoriasis were reported in 35.4% of the 24 controls. The MASEI scores ranged from 0 to 52, with a mean of 14.72 and a standard deviation of 11.60 (81 patients had MASEI scores ≥20, representing 55.5%). The major-