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Molluscum contagiosum eyelid lesions in an HIV-patient

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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, Portugal


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.


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 1Figure 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.


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].


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