Case Of Molluscum Contagiosum Research Articles

Unusual Manifestation of Molluscum Contagiosum: Eruptive Papules on the Face and Neck of an Immunocompetent Patient

Dear Editor: Molluscum contagiosum (MC) is a common benign skin disease caused by the pox virus and usually affects young children. Most MC in adults occurs in people with an immunosuppressive status, but it can also appear in immunocompetent adults who have experienced friction or scrubbing. We herein report a case of MC that presents multiple pinhead-sized eruptive skin-coloured papules covering the whole face and neck in a patient without a history of epidermal trauma. A 60-year-old Korean woman with a history of recent onset diabetes presented to our clinic with sudden eruptive papules on her face and neck, which had been persistent for the past 6 months. She had been treated with topical hydrocortisone in the local clinic, but no improvements were observed. Even though she was mostly asymptomatic, the patient complained of occasional mild pruritus. She had no history of towel scrubbing or massage. Upon physical examination, multiple 2 to 3-mm-sized skin-coloured papules were observed on her face and neck (Fig. 1). Fig. 1 (A) Multiple 2- to 3-mm-sized skin-coloured papules observed on the face and neck. (B) Close up view of the skin-coloured papules. Keratin-like material was observed after extractions of some lesions, resulting in the performance of punch biopsy under the initial impression of milium. Histopathologic examination revealed epidermal cells bearing large eosinophilic cytoplasmic inclusion bodies, typical of the molluscum body, and the lesion was diagnosed as MC (Fig. 2). Due to diffuse distributions across the face and neck, imiquimod cream, oral gamma linolenic acid 360 mg and oral cimetidine 2,000 mg were used daily for 3 months, until all the lesions were resolved. We believe that the immunomodulating effects from imiquimod cream and oral cimetidine could have contributed to the resolution. Fig. 2 Epidermal cells bearing large eosinophilic cytoplasmic inclusion bodies, typical of the molluscum body (H&E, ×100). There have been several reports of disseminated molluscum contagiosum in patients with hematologic malignancies, human immunodeficiency (HIV) infection, or in patients taking immunosuppresants such as methotrexate or azathioprine1,2. Cases associated with traumas and contacts have also been reported, such as molluscum folliculitis after shaving or molluscum developed after use of a nylon towel at a public spa3,4. In this case, the patient was a healthy woman without any evidence of systemic diseases other than diabetes and was not taking any medicine that could impair cellular immunity. Lab data including complete blood counts and routine chemistry were within normal values and venereal disease research laboratory (VDRL) was non-reactive. Anti-HIV antibodies were also negative. In addition, she had no history of shaving, friction or massage, which might cause the inoculation of pox virus from epidermal trauma. However, an incidental MC infection could have spread to her whole face and neck due to the application of hydrocortisone cream after a misdiagnosis. In conclusion, our case suggests that dermatologists should perceive various clinical features of MCs in order to avoid misdiagnosis due to unusual clinical features. Additionally, the diagnosis of mollosum contagiosum should not be excluded, even if the patient is a healthy person without immunodeficiency.

Intraoral molluscum contagiosum in a young immunocompetent patient

Molluscum contagiosum (MC) is a contagious disease caused by a virus of the poxvirus family. In children, the disease commonly manifests as a variable number of discrete umbilicated papules on the face and trunk. In healthy and immunosuppressed adults, the disease appears on or near the genital organs and is often sexually transmitted. MC involving the intraoral mucosa has been documented but is rare. We report a case of MC involving the oral mucosa exclusively and discuss the main clinical, histopathologic, and therapeutic characteristics, comparing the findings with cases of this rare oral presentation described in the literature.

Kaposi Sarcoma in Association With Molluscum Contagiosum: An Uncommon Diagnosis in a Single Biopsy and Potential Diagnostic Pitfall

Molluscum contagiosum is a cutaneous poxviral infection that is rarely associated with other skin diseases, such as cutaneous neoplasms. Such associations are likely to be coincidental, except in immunocompromised patients. Kaposi sarcoma, an angioproliferative neoplasm derived from lymphatic endothelium, is mediated by human herpes virus-8 infection and occurs with increased frequency in immunocompromised individuals. We report an unusual case of molluscum contagiosum with underlying cutaneous Kaposi sarcoma diagnosed in a single skin biopsy of a human immunodeficiency virus-positive patient. Our case highlights the importance of adequate sampling to avoid missing secondary diagnoses in histopathologic sections and alerts pathologists and dermatologists to the possibility of coinfection in high-risk patients by 2 virally-mediated skin conditions.

HIV感染者に生じ，多剤併用療法後に自然消退した伝染性軟属腫の1例

43歳，男性。2008年2月より顔面に常色の硬い小結節が出現し，急速に個数が増加した。HIV感染症に対して2008年10月初めより多剤併用療法を開始したところ，1ヵ月後には約半数のものに強い紅暈を生じ，さらに1ヵ月後には小結節は無治療ですべて消失した。伝染性軟属腫発症時のCD4陽性リンパ球数(以下CD4値)は27/μl，治癒時CD4値は342/μlであった。自験例を含め，当科において経験したHIV感染者に生じた伝染性軟属腫6例を合わせて報告する。伝染性軟属腫はCD4値が100/μl以下と低値であるときに発症することが多く，多剤併用療法施行によりCD4値が回復すると伝染性軟属腫も治癒する傾向があると思われる。

Molluscum contagiosum involving an epidermoid cyst with xanthogranuloma‐like reaction in an HIV‐infected patient

Molluscum contagiosum (MC) causes characteristic cutaneous lesions that occur mainly in children, sexually active adults, and immunocompromised individuals, especially those with human immunodeficiency virus (HIV) infection. Patients infected with HIV, particularly those with advanced disease, have an increased incidence, up to 33.3%, of MC in non-anogenital areas. MC has been rarely found to be associated with epidermoid cysts. A 44-year-old male with HIV infection presented with the complaint of a-3-month history of a tender nodule on the left neck. H&E stained sections showed a ruptured cyst, lined with squamous epithelium showing cytopathic changes of MC, and a xanthogranuloma-like inflammatory reaction with characteristic Touton-type giant cells. MC infections are common, however MC associated with epidermoid cysts is infrequent. A few cases of MC occurring in epidermoid cysts have previously been reported. We are presenting a case of MC involving an epidermoid cyst in an AIDS patient, with a unique xanthogranuloma-like reaction. Xanthogranulomatous (XG) reactions have been infrequently reported in association with other viral infections, however, poxvirus-associated XG reaction has only been observed in animals. This is the first reported case of MC-associated XG reaction in humans.

Molluscum contagiosum arising in melanocytic nevus and in superficial spreading melanoma

Molluscum contagiosum (MC) is common skin infection caused by molluscum virus. Growth of MC inside melanocytic lesion is extremely rare. We present the case of MC in common melanocytic nevus and the first case of MC in superficial spreading malignant melanoma. Complete destruction of melanocytes and melanoma cells occurred on the site of MC infection. MC virus might be considered as a future candidate for viral oncolysis in cutaneous melanoma patients with advanced disease.

Disfiguring molluscum contagiosum in a HIV-positive patient responding to antiretroviral therapy

Molluscum contagiosum (MC) is caused by a double stranded DNA virus belonging to the pox virus family. MC lesions are usually pearly, dome shaped, small, discrete lesions with central umbilication. In HIV-positive patients atypical varieties are found. They may be large or nonumbilicated. Individual papules may join to form the agminate variety. This form is rare. Lesions of MC in healthy immunocompetent patients may occur at any part of the body including face, trunk, and limbs. Sexually active adults have lesions usually on the genitalia, pubis, and inner thigh, rarely on the face and scalp. We present a case of agminate MC occurring in a patient with acquired immunodeficiency disease responding to highly active antiretroviral therapy.

Unusual Presentations of Molluscum Contagiosum

Molluscum contagiosum is a common viral skin infection. Unusual presentations of this condition among immunocompetent individuals have rarely been reported. To highlight atypical clinical presentations of molluscum contagiosum in immunocompetent individuals. An analysis of all cases of molluscum contagiosum with unusual presentation seen over a period of 2 years in the Farwaniya Department of Dermatology was conducted. Four patients (two males, two females), aged 13 to 35 years, with atypical molluscum contagiosum were encountered. Diagnosis was confirmed histopathologically. All of them were healthy, immunocompetent individuals without any underlying skin condition, except one who had preceding hand dermatitis. Clinical clues that could be helpful in making a diagnosis of molluscum contagiosum with an atypical presentation were looked for. A histopathologic examination may be necessary to make the diagnosis.

Molluscum contagiosum: histologic patterns and associated lesions. A study of 578 cases.

Molluscum contagiosum (MC) is rarely associated with other skin diseases, especially cutaneous neoplasms. Such associations are exceptional and of unknown frequency. The aim of this study was to record the histologic variants and frequency of associated lesions in a large series of consecutive MC cases. We reviewed 578 MC cases from the Laboratory of Dermatopathology of the University Hospitals of Strasbourg, France (1959-1999). The locations of MC were as follows: head and neck (34.7%), trunk (27.1%), lower limbs (20.7%), upper limbs (8.7%), and genitalia (3.8%). Molluscum contagiosum occurred more often in female patients (56.7%). The age range of patients included in this study was 0 to 19 years (34.9%), 20 to 39 years (31.1%), 40 to 59 years (22.8%), and over 60 years (6.5%). Histologic variants of MC were noted in 46 cases (31 pseudocystic, 8 giant, and 7 pedunculated). An underlying abscess was present in 65 cases. Of the 578 cases, 22 were associated with other lesions (3.8%). There were 9 cases of epidermal cysts, 4 of nevocellular nevi, 3 of metaplastic ossifications, 2 of true epidermal nevi, 2 of sebaceous hyperplasias, 2 of soft fibromas, and 1 of Kaposi sarcoma. Except in immunocompromised patients, such associations are likely to be coincidental. The clinical diagnosis was correct in 42.3% of the cases. Clinical accuracy varied according to the age, localization, and histologic pattern of MC. Pseudocystic MC, giant MC, and MC associated with other lesions were responsible for frequent clinical misdiagnosis.

A Case of Molluscum Contagiosum with Atypical Clinical Features and Histopathology

A Case of Molluscum Contagiosum with Atypical Clinical Features and Histopathology

Intraoral molluscum contagiosum

Molluscum contagiosum (MC) presenting as a self-limiting disease of the skin is not uncommon. To date, however, documented cases of MC of the oral cavity have been rare. A case of MC of the palate of a 52-year-old man is reported. The clinical and histopathologic features of this uncommon oral lesion are discussed, and the literature is reviewed.

Spontaneous Disappearance of Molluscum Contagiosum

We report herein a case of molluscum contagiosum that healed spontaneously. The molluscum papules did not involute simultaneously, but became inflamed and disappeared individually over a period of months. Biopsy specimens were taken at various stages of inflammation and regression. The histopathology was consistent with a cell-mediated rejection reaction.

Molluscum Contagiosum Occurring in Epidermal Inclusion Cysts

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An epidemiologic study of molluscum contagiosum in Anchorage, Alaska

Several cases of molluscum contagiosum are reported from Anchorage, Alaska, thefirst such report from a subarctic area, and the first family study. There were thirteen cases in 46 family members exposed. The ages of those attacked were from 10 months to 13 years. Seventy-seven per cent of the males under 14 were infected, as opposed to 20 per cent of females under 14 years of age. The duration of lesions was from 2 weeks to 1 1/2 years. Recurrences were apparent in 8 of the 13 cases. Intrafamily spread could be demonstrated in only two of the eight families studied.

Therapeutic value of chloramphenicol in a group of dermatoses of established or questionable virus etiology.

THE AVAILABILITY of chloramphenicol (chloromycetin® 1 ), an agent found effective against certain viruses, suggested its use as a therapeutic agent in the group of dermatoses selected for this study. I have treated 76 patients with the agent up to the time of this report, and the results have been sufficiently interesting that I believe a preliminary report is justified. A group of dermatoses in which there has been an established or questionable virus etiology were included in this study. The erratic response of several of these diseases to all forms of therapy is well known, and they therefore offered an excellent therapeutic test for the use of chloramphenicol. Thirteen cases representing the erythema multiforme group, 7 cases of pemphigus vulgaris, 8 cases of herpes zoster, 5 cases of herpes simplex, 32 cases representing the verruca group, 3 cases of molluscum contagiosum, 3 cases of varicella and 5

MOLLUSCUM CONTAGIOSUM TREATED WITH SULFADIAZINE

In 1941 Sommerville 1 reported on 8 cases of molluscum contagiosum in which the patients had been treated with sulfapyridine. In 6 cases the disease cleared completely, and in 2 it was necessary to stop the treatment within a short time because of toxic reactions to the drug. Sommerville pointed out that sulfapyridine had a definite lethal effect on the causative virus of molluscum contagiosum. Four of Sommerville's patients who took sulfapyridine regularly in doses of 30 to 60 grains (2 to 4 Gm.) daily were cured within varying periods of two to eight weeks. For 2 patients who took the drug only at irregular intervals three to four months was required for complete cure. Two patients who failed to respond when the daily dose was 15 grains (1 Gm.) had clearing when the dosage was increased to 30 grains daily. Of the 6 patients who were cured, 5 were