Disseminated and Disfiguring Molluscum Contagiosum in a Child

Abstract

We report widely disseminated and disfiguring lesions of molluscum contagiosum occurring in a 4-year-old girl secondary to a primary immunodeficiency disorder. The child, born of consanguineous parents, had multiple, asymptomatic, raised, skin-colored and whitish lesions since 2 years of age. On physical examination she had growth retardation features with grade II protein energy malnutrition. Cutaneous examination revealed numerous, widespread, skin-colored to translucent, firm, umbilicated papules of varying sizes (pinpoint to larger than 10 mm). They were distributed bilaterally over all four limbs, including the dorsum of the hands and feet, trunk, face (including lips), eyelids, auriculae, and perineal and gluteal areas. In places, they were linearly disposed and had coalesced to form plaques. A biopsy specimen from a representative skin lesion (arm) demonstrated lobulated epidermal growth consisting of keratinocytes with large intracytoplasmic eosinophilic inclusion bodies and a central crater. These findings were consistent with the diagnosis of molluscum contagiosum. Topical therapies with phenol and trichloroacetic acid were ineffective The child succumbed to a fulminant systemic infection at home, 2 months after discharge from the hospital. The extent and distribution of molluscum contagiosum in our patient was remarkably vivid and has been hitherto reported only rarely.

Unusual Presentations of Molluscum Contagiosum

“…Atypical cases of MC in healthy patients, occurring at usual sites, have rarely been reported. 8,9 Herein we present four cases of unusual clinical variants of MC occurring at usual sites, in the absence of any known immunocompromised state.…”

Disseminated molluscum contagiosum in a patient with chronic plaque psoriasis taking methotrexate

“…Infection with molluscum contagiosum has been reported in patients with primary and acquired immunodeficiencies 1,2 . In such circumstances, widespread cutaneous infection by the virus may result in rapid development of molluscum lesions numbering >100.…”

“…In such circumstances, widespread cutaneous infection by the virus may result in rapid development of molluscum lesions numbering >100. There is a high prevalence of molluscum contagiosum in patients with acquired immunodeficiency syndrome, with the disease being a marker of HIV progression and very low CD4 cell counts 1 . Immunologically, molluscum contagiosum has been shown to enhance survival by interfering with the tumour necrosis factor (TNF) receptor‐induced apoptosis of virus‐infected cells.…”

Giant molluscum contagiosum: An unusual presenting complaint of paediatric HIV disease

“…There are many case reports of giant MC in adult HIV seropositive patients, though lesions involving the whole of the face in a child has only been reported in two cases. 9,10 The diagnosis is best established by biopsy staining of the curdy material with Giemsa and demonstration of eosinophilic molluscum bodies.…”