Epibulbar molluscum contagiosum lesions in multiple myeloma

To describe the history and clinical presentation of a case of primary epibulbar molluscum contagiosum in multiple myeloma, after penetrating keratoplasty.

A 70-year-old man, with previously diagnosed multiple myeloma and atopic dermatitis and keratoconjunctivitis, presented 6 months after right penetrating keratoplasty with white multilobular nodules of the right limbus. No skin lesions were evident. Evaluation consisted of slit-lamp examination, and an excisional biopsy of the involved conjunctival epithelium was carried out with local cryotherapy. Excised tissue was sent for histopathologic studies.

Slit-lamp examination revealed the presence of eight, 1-3 mm nodules of the perilimbal conjunctiva. In addition, there were opaque plaques at the level of the corneal epithelium. Mild perilesional conjunctival injection was evident, but there was no follicular conjunctival reaction. Histopathologic study of the lesions revealed eosinophilic intracytoplasmic inclusions (molluscum bodies) within the epithelial tissue.

There are no other reports of primary epibulbar molluscum, without previous cutaneous lesions, in immunocompromised patients without AIDS or after keratoplasty. This diagnosis should be included in the differential of focal thickening of the conjunctival epithelium, and potentially the corneal epithelium, in immunosuppressed patients.