A 54-year-old male kidney transplant recipient, and receiving immunosuppressive treatment with tacrolimus, mycophenolate mofetil and prednisolone and a previous history of cytomegalovirus (CMV) disease. He was admitted with painful and hemorrhagic oral lesions (Fig. 1), associated with rapidly deterioration of health status, fever, dysphagia, and odynophagia. A swab of the oral lesions identified Herpes simplex 1 virus by Polymerase Chain Reaction. High blood CMV viral load and oral tissue biopsy confirmed the diagnosis of CMV disease with herpetic co-infection. The patient was started on ganciclovir with significant clinical improvement on day seven (Fig. 2).

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