Solitary Giant Molluscum Contagiosum of the Sole

Abstract

Molluscum contagiosum of the sole is extremely rare and only three cases have been reported in the literature. We report a solitary giant molluscum contagiosum on the left sole of a 5-year-old boy, which should be clinically differentiated from plantar wart, eccrine poroma, epidermal cyst, foreign body granuloma, cryptococcal infection, and pyogenic granuloma.Molluscum contagiosum is a common viral disease produced by the poxvirus. Clinically the cutaneous lesions are characterized by multiple, umbilicated papules which usually appear on the face, trunk, and extremities in children (1). Although molluscum contagiosum itself may sometimes show an atypical presentation in number, size, or location, a single giant lesion of the sole is very rare. We report an unusual molluscum contagiosum presenting as a solitary large nodule of the sole. CASE REPORTA 5-year-old boy had an elevated erythematous nodule on the left sole of 6 month's duration. Examination revealed a 1.5 cm x 1.2 cm, firm, tender nodule with a verrucous surface and rolled margin on the plantar area of the left foot (Fig. 1). He had no similar lesions anywhere else on his body. He had a past history of minor trauma to his sole 7 months before. He had no past medical history of systemic disease and no evidence of immunodeficiency. A punch biopsy was done, and then the nodule was treated with curettage and electrodesiccation under the diagnosis of plantar wart.Histopathologic examination showed epithelial hyperplasia with numerous inclusion bodies and moderate inflammatory cell infiltration of the underlying dermis (Fig. 2). The electron microscopic findings showed rnature viral particles with a biconcave disk appearance of the core surrounded by an electron-lucent halo (Fig. 3). Three months later the lesion cleared, and there was no evidence of recurrence.

Molluscum contagiosum of the sole

“…In children, MC is transmitted by close physical contact, fomites or autoinoculation, whereas in adults, the disease is spread mainly through sexual contact. Although the exact means of transmission in our patient is unknown, prior trauma was assumed to be a predisposing factor in a similar case 6 …”

“…Typical localizations of MC involve the face, trunk and extremities in children and the lower abdominal wall, inner thighs, pubic area and genitalia in adults. The lesions also rarely develop on conjunctiva, 4 oral mucosa 5 or on the sole 6–9 . MC of the sole is extremely rare, and only four cases have been previously reported.…”

UK national guideline for the management of Genital Molluscum in adults, 2014 Clinical Effectiveness Group, British Association for Sexual Health and HIV

“…36,37 Molluscum infection can affect almost any part of the body, rarely even the oral cavity 38–40 or sole of the foot. 41–43 Molluscum lesions are frequently asymptomatic, though occasionally associated with itch, discomfort or secondary bacterial infection. Molluscum infection will usually regress spontaneously within months in immunocompetent individuals, leaving no sequelae.…”

Interdigital molluscum contagiosum on the foot

“…HIV infection seems to be a predisposing factor for atypical locations of MC . Ha et al . also suggested that prior trauma might be a predisposing factor in the occurrence of plantar MC.…”

“…Although MC can be seen in any location, oral and conjunctival mucosae and plantar involvement were reported rarely . MC can be diagnosed clinically; however, diagnosis can be difficult in unusual locations.…”