Thread by @guerreroespejo

42-YO African American man, AIDS, CD4 57 cells/ mm3: 18-mth of progressively multiple papules coalescing into large exophytic nodules & plaques on face, scalp, & neck (A & B); & several lesions in in the groin, penis, & RUE
🔬:?
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doi.org/10.1093/cid/ci…
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GIANT MOLLUSCUM CONTAGIOSUM

Molluscum contagiosum is a benign skin tumor caused by molluscum contagiosum virus.

Lesions >1 cm diameter are known as giant molluscum
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Well-circumscribed intraepidermal lobules containing molluscum bodies (arrow)
These structures, which are composed of viral particles & cellular debris, are pathognomonic for this condition
Molluscum bodies enlarge and rise to the surface as cells age
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The typical lesion of molluscum contagiosum is smooth, dome-shaped, pearly or flesh-colored, often umbilicated, and always spares the palms and soles.
Approximately 10%–20% of patients with symptomatic HIV infection or AIDS have molluscum contagiosum
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Patients with #AIDS may have atypical presentations of molluscum contagiosum, such as molluscum without umbilication, molluscum as an abscess, tender molluscum, or erythematous nodular molluscum.
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Transmission routes include skin contact, fomite contact,& sexual transmission

The disease lasts for 6–9 months, although individual lesions tend to regress after ∼2 months

The cell-mediated immune system is most responsible for the defense against and resolution of lesions
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The cellular immunodeficiency in AIDS therefore predisposes to such infections
In HIV-infected individuals, lesions occur on the face &/or intertriginous areas & tend to be prolonged, severe & resistant to treatment. The number of lesions is inversely related to the CD4 count
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In HIV-infected individuals, the lesions tend to regress with highly active antiretroviral therapy and immune reconsititution.
Topical 3% cidofovir, imiquimod & other have both been shown to be beneficial
Cryotherapy and mechanical curettage are also effective

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