Umbilicated papules in an immunocompromised patient

Area of Science:

• Dermatology
• Infectious Diseases
• Immunology

Background:

• Human immunodeficiency virus (HIV) infection compromises the immune system, increasing susceptibility to opportunistic infections and atypical presentations of common conditions.
• Molluscum contagiosum, a viral skin infection, can present with varied morphology, posing diagnostic challenges, especially in immunocompromised patients.

Purpose of the Study:

• To present a case of atypical molluscum contagiosum in an HIV-positive patient.
• To emphasize the diagnostic role of histopathology in differentiating molluscum contagiosum from other cutaneous conditions in immunocompromised individuals.
• To highlight the therapeutic efficacy of highly active antiretroviral therapy (HAART) in managing molluscum contagiosum in the context of HIV.

Main Methods:

• Clinical presentation review of a 68-year-old male with HIV and characteristic skin lesions.
• Differential diagnosis consideration including opportunistic infections like histoplasmosis and cryptococcosis.
• Histopathological examination of skin biopsy specimens to identify epidermal hyperplasia and Henderson-Patterson bodies, confirming molluscum contagiosum.
• Exclusion of fungal infections through negative fungal stains, cultures, and antigen tests.

Main Results:

• Histopathology confirmed molluscum contagiosum, characterized by epidermal hyperplasia and Henderson-Patterson bodies.
• Opportunistic fungal infections (cryptococcosis, histoplasmosis) were ruled out by laboratory investigations.
• The patient initiated HAART for immune reconstitution.

Conclusions:

• Histopathology is essential for accurate diagnosis of molluscum contagiosum, distinguishing it from opportunistic infections in immunocompromised patients.
• Highly active antiretroviral therapy (HAART) is a critical intervention for immune reconstitution and management of molluscum contagiosum in HIV-infected individuals.