Molluscum contagiosum eyelid lesions in an HIV-patient
Published Web Location
https://doi.org/10.5070/D32dc3w4mbMain Content
Molluscum contagiosum eyelid lesions in an HIV-patient
António Fernandes Massa MD, João Borges-Costa PhD, Luís Soares-Almeida PhD, Manuel Sacramento-Marques MD
Dermatology Online Journal 19 (1): 10
Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, PortugalAbstract
Molluscum contagiosum (MC) lesions on the face are mainly observed in HIV patients and are related to low CD4 cells counts. We report a 41-year-old female patient infected with human immunodeficiency virus who had a CD4 count of 22 cells/mm³. She developed molluscum contagiosum lesions at the right upper eyelid. Skin biopsy was performed to exclude other serious conditions, such as dimorphic fungal infections. A good response was observed with three sessions of curettage and topical application of 70 percent trichloroacetic acid. Facial molluscum contagiosum lesions can be a cutaneous marker of severe immunosuppression in HIV patients and skin biopsy is important in ruling out the diagnosis of dimorphic fungal infections.
Introduction
Molluscum contagiosum is a virus, a member of the poxviridae family. Infection is commonly observed in children, sexual active adults, and immunosuppressed patients.
Although these lesions are generally self-limiting, in patients with weakened immune systems they may persist for prolonged periods [1] and recalcitrant disease is observed [2, 3]. In human immunodeficiency virus type 1-positive (HIV-1) patients, widespread [4] lesions may also occur, but head and neck involvement is most common, followed by genital involvement [4, 5, 6, 7]. These patients may also exhibit an atypical presentation such as giant molluscum [3]. Severe involvement can occur as a late manifestation of HIV infection, being a cutaneous correlate of cellular immune deficiency [8]. Although molluscum contagiosum is a manifestation of HIV that may improve with initiation of Highly Active Anti-Retroviral Therapy (HAART) [9, 10], it can also appear as a manifestation of the immune reconstitution inflammatory syndrome [11]. Interestingly, molluscum contagiosum incidence increases with HAART use. Whereas disseminated molluscum is often observed in severely immunocompromised patients, the increased incidence among HAART users may be a result of the immunologic recovery syndrome in which previously unidentified viral antigens are recognized after initiation of treatment [12, 13, 14, 15].
Clinical case
 |  |
| Figure 1 | Figure 2 |
|---|---|
| Figure 1. Umbilicated pearly papules in the right upper eyelid Figure 2. The classical Henderson-Patterson bodies (H&E) | |
We report a 41-year-old female patient, infected with HIV-1 since 1997, who presented to our outpatient clinic because of umbilicated pearly papules at the right upper eyelid that she had for two months (Figure 1).
The patient denied previous infection with molluscum contagiosum and was medicated with trimethropim/sulfamethoxazole, nevirapine, and emtricitabine/tenofovir. Hydrocortisone 1 percent cream had been used for ipsilateral eyelid dermatitis one month before. The CD4 count was 22 cells/mm³. On physical examination molluscum contagiosum lesions were not observed on genital skin. Skin biopsy was performed to exclude other infections and it showed the classical Henderson- Patterson bodies (Figure 2). A good response was observed with three sessions of curettage and topical application of 70 percent trichloroacetic acid. The patient is now under regular clinical surveillance.
Conclusions
Facial molluscum contagiosum lesions can be associated with severe immunosuppression in HIV patients and their incidence, despite HAART introduction, has not diminished. Dermatologists must be aware that this infection can be one of the cutaneous markers of a drop in CD4 cell count. Skin biopsy is also important in making the differential diagnosis between dimorphic fungal infections such as histoplasmosis [16] and cryptococcosis [17, 18, 19, 20] that may have a similar appearance [16, 17, 18, 19, 20] and can also coexist in the same lesion [21, 22].
References
1. Tyring S. Molluscum contagiosum: the importance of early diagnosis and treatment. Am J Obstet Gynecol 189(3): S12-16 (2003). [PubMed]2. Theiler M, Kempf W, Kerl K, French LE, Hofbauer GF. Disseminated molluscum contagiosum in a HIV-positive child. Improvement after therapy with 5% imiquimod. J Dermatol Case Rep. 2011 Jun 6;5(2):19-23. [PubMed]
3. Sisneros SC; Recalcitrant giant molluscum contagiosum in a patient with advanced HIV disease - eradication of disease with paclitaxel. Top HIV Med. 2010 Dec;18(5):169-72. [PubMed]
4. Chularojanamontri L, Tuchinda P, Kulthanan K, Manuskiatti W. Generalized molluscum contagiosum in an HIV patient treated with diphencyprone. J Dermatol Case Rep. 2010 Dec 31;4(4):60-2 [PubMed]
5. Gottlieb SL, Myskowski PL. Molluscum contagiosum. Int J Dermatol 1994; 33: 453-461. [PubMed]
6. Epstein WL. Molluscum contagiosum. Semin Dermatol 1992; 11: 184-189.
7. Lewis EJ, Larn M, Crutchfield CE. An update on molluscum contagiosum. Cutis 1997; 60: 29-34. [PubMed]
8. Schwartz JJ, Myskowski PL. Molluscum contagiosum in patients with human immunodeficiency virus infection: A review of twenty-seven patients. J Am Acad Dermatol 27(4):583-8 (1992). [PubMed]
9. Schulz D, Sarra G, Koerner U, Garweg J. Evolution of HIV 1-related conjunctival molluscum contagiosum under HAART: report of a bilaterally manifesting case and literature review. Graefes Arch Clin Exp Ophthalmol 2004; 242 (11): 951-5. [PubMed]
10. Calista D, Boschini A, Landi G: Resolution of disseminated molluscum contagiosum with Highly Active Anti-retroviral therapy (HAART) in patients with AIDS. Eur J Dermatol 1999; 9 (3):211-3. [PubMed]
11. Pereira B, Fernandes C, Nachiambo E, Catarino MC, Rodrigues A, Cardoso J. Exuberant molluscum contagiosum as a manifestation of the immune reconstitution inflammatory syndrome. Dermatol Online J. 2007 May 1;13(2):6. [PubMed]
12. Munoz-Perez MA, Rodriguez-Pichardo A, Camacho F, Colme- nero MA. Dermatological findings correlated with CD4 lymphocyte counts in a prospective 3 year study of 1161 patients with human immunodeficiency virus disease predominantly acquired through intravenous drug abuse. Br J Dermatol 1998;139:33-9. [PubMed]
13. Albini T, Rao N. Molluscum contagiosum in an immune reconstituted AIDS patient. Br J Ophthalmol 2003;87: 1427-8. [PubMed]
14. French MA, Lenzo N, John M, Mallal SA, McKinnon EJ, James IR, et al. Immune restoration disease after the treatment of immunodeficient HIV-infected patients with highly active antiretroviral therapy. HIV Med 2000;1:107-15. [PubMed]
15. Zancanaro PC, McGirt LY, Mamelak AJ, Nguyen RH, Martins CR. Cutaneous manifestations of HIV in the era of highly active antiretroviral therapy: An institutional urban clinic experience. J Am Acad Dermatol 2006;54:581-8. [PubMed]
16. Feuilhade de Chauvin M, Revuz J, Deniau M. Histoplasma duboisii histoplasmosis. Skin lesions simulating molluscum contagiosum. Ann Dermatol Venereol. 1983;110(9):715-6. [PubMed]
17. Ghigliotti G, Carrega G, Farris A, Burroni A, Nigro A, Pagano G, De Marchi R. Cutaneous cryptococcosis resembling molluscum contagiosum in a homosexual man with AIDS. Report of a case and review of the literature. Acta Derm Venereol. 1992;72(3):182-4. [PubMed]
18. Concus AP, Helfand RF, Imber MJ, Lerner EA, Sharpe RJ; Cutaneous cryptococcosis mimicking molluscum contagiosum in a patient with AIDS. J Infect Dis. 1988 Oct;158(4):897-8. [PubMed]
19. Jiménez-Acosta F, Casado M, Borbujo J, Soto-Melo J, Viguer JM, Sanjurjo MJ. Cutaneous cryptococcosis mimicking molluscum contagiosum in a haemophiliac with AIDS. Clin Exp Dermatol. 1987 Nov;12(6):446-50. [PubMed]
20. Ramdial PK, Calonje E, Sing Y, Chotey NA, Aboobaker J. Molluscum-like cutaneous cryptococcosis: a histopathological and pathogenetic appraisal. J Cutan Pathol. 2008 Nov;35(11):1007-13. [PubMed]
21. Annam V, Inamadar AC, Palit A, Yelikar BR. Co-infection of molluscum contagiosum virus and cryptococcosis in the same skin lesion in a HIV-infected patient. J Cutan Pathol. 2008 Oct;35 Suppl 1:29-31. Epub 2008 Jun 9. [PubMed]
22. Sulica RL, Kelly J, Berberian BJ, Glaun R. Cutaneous cryptococcosis with molluscum contagiosum coinfection in a patient with acquired immunodeficiency syndrome. Cutis. 1994 Feb;53(2):88-90. [PubMed]
© 2013 Dermatology Online Journal