Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obervation Letter
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Letter To Editor
2008:74:3;267-268
doi: 10.4103/0378-6323.41382
PMID: 18583804

Resolution of giant Molluscum contagiosum with antiretroviral therapy

Sumit Sen, Parna Bhaumik
 Department of Dermatology, North Bengal Medical College and Hospital, Darjeeling, West Bengal, India

Correspondence Address:
Sumit Sen
Department of Dermatology, North Bengal Medical College and Hospital, Susrutnagar, District Darjeeling, West Bengal
India
How to cite this article:
Sen S, Bhaumik P. Resolution of giant Molluscum contagiosum with antiretroviral therapy. Indian J Dermatol Venereol Leprol 2008;74:267-268
Copyright: (C)2008 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

Large-sized Molluscum contagiosum known as giant molluscum have been reported to occur in AIDS patients with low CD4 lymphocyte counts and they often present diagnostic difficulties. Molluscum contagiosum occurring in symptomatic HIV-infected patients are usually recalcitrant to treatment. We present here a case of multiple giant Molluscum contagiosum , showing excellent response to antiretroviral therapy (ART).

A 46 year-old unmarried laborer presented to the dermatology department with sessile, dome-shaped, dull red and mildly tender nodules on his forehead, varying in size from 6 mm to more than 2 cm (giant molluscum), present for the last one and a half years. The nodule in the center of the forehead was about 2.3 cm in diameter and had a crater-like depression [Figure - 1]. There were smaller, nontender lesions on his cheek, nose, lower lip, trunk and scrotum. He had regularly visited female commercial sex workers for the last two years and had also had homosexual relationships with two males. He tested positive on two successive occasions for HIV with the use of the ELISA technique; his CD4 lymphocyte count was found to be 69 cells/mm 3 . His ESR was 130 mm at the end of one hour and an X-ray of the chest was inconclusive. A biopsy showed lobulated epidermal hyperplasia displaying basophilic intracytoplasmic inclusion bodies. The patient was initiated on antiretroviral therapy (ART) with zidovudine 300 mg, lamivudine 150 mg and nevirapine 150 mg, all given twice daily. Nine months after starting ART, it was seen that the lesions on his trunk and genitalia had regressed. All the nodules on the forehead had disappeared leaving only hyperpigmented spots [Figure - 2]. A blood test revealed his CD4 lymphocyte count to be 194 cells/mm 3 . Two months later, there was no sign of recurrence.

Molluscum contagiosum occurring in HIV-positive patients may attain sizes greater than 10 mm and resemble tumors and deep fungal infection. In these patients, they are commonly extragenital. [1] Lesions are more common in those with homosexual practices than in those taking drugs via the intravenous (IV) route. [2] Our patient had genital lesions as well and was bisexual in nature. He categorically denied any IV drug usage.

Molluscum contagiosum in HIV infection is reliably diagnosed by skin biopsy. Giemsa stain of the material obtained from a crushed papule also demonstrates the presence of "molluscum bodies" in the cells of the epidermis. The usual histopathological picture shows eosinophilic molluscum bodies crowded into the cells of the spinous layer. Their staining pattern changes above the granular layer where they become basophilic, as seen in our case. Histological variants seen in immunocompromised patients are pseudocystic and polypoidal types. [3] These were not seen in our patient′s biopsy.

Cidofovir (1-3%) cream or ointment [4] and electron beam therapy [5] have been used effectively to treat extensive lesions in the immunosuppressed but are not easily available. Facial mollusca of the giant type and especially those found in HIV-infected patients do not respond well to treatment. Intralesional interferon used in resistant facial mollusca [6] and topical imiquimod [7] were avoided as they were costly. Therapies targeted at boosting the immune system in the immunocompromised have proven to be most effective in such cases. [8]

Our case had a number of atypical and giant mollusca on the forehead in addition to genital lesions. Some of the lesions on the forehead mimicked keratoacanthomas. They responded satisfactorily when the primary disease was treated with HAART.

References
1.
Dhar S, Jain S, Verma G, Tanwar R. Disseminated and atypical Molluscum contagiosum in an AIDS patient. Indian J Dermatol Venereol Leprol 1996;62:331-2.
[Google Scholar]
2.
Raynaud- Mendel B, Janier M, Gerbeka J. Dermatologic findings in HIV-1 infected patients a prospective study with emphasis on CD4 + cell count. Dermatology 1996;192:325-8.
[Google Scholar]
3.
Mansur AT, Goktay F, Gunduz S, Serdar ZA. Multiple giant Molluscum contagiosum in a renal transplant recipient. Transpl Infect Dis 2004;6:120-3.
[Google Scholar]
4.
Calista D. Topical cidofovir for severe cutaneous human papilloma virus and Molluscum contagiosum infection in patients with HIV/AIDS: A pilot study. J Eur Acad Dermatol Venereol 2000;14:484-8.
[Google Scholar]
5.
Scolaro MJ, Gordon P. Electron beam therapy for AIDS related Molluscum contagiosum lesions: Preliminary experience. Radiology 1999;210:479-82.
[Google Scholar]
6.
Nelson MR, Chard S, Barton SE. Intralesional interferon for the treatment of recalcitrant Molluscum contagiosum in HIV antibody positive individuals: A preliminary report. Int J STD AIDS 1995;6:351-2.
[Google Scholar]
7.
Liota E, Smith KJ, Bukley R,Menon P, Skelton F. Imiquimod therapy for Molluscum contagiosum . J Cutan Med Surg 2000;4:76-82.
[Google Scholar]
8.
Hicks CB, Myers SA, Giner J. Resolution of intractable Molluscum contagiosum in a human immunodeficiency virus infected patient after institution of anti-retroviral therapy with ritonavir. Clin Infect Dis 1997;24:1023-5.
[Google Scholar]

Fulltext Views
191

PDF downloads
47
Show Sections