Figure 4. Routine histologic section from the patient described in (Figure 3). Left. The many cytomegalic cells show infection of various cell types including vascular endothelium (small arrow), fibroblasts (medium arrow), and smooth muscle cells (large arrow) (original magnification, x 200). Right. Most of the endothelial cells in the three blood vessels shown are cytomegalic. Ischemia as a result of vascular occlusion may be important in the pathogenesis of ulceration (original magnification, x 200).