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Molluscum contagiosum is a common viral infection in the immuno-compromised HIV-positive patient where it is often severe and affecting the face and neck. It is frequently resistant to conventional, locally destructive therapies. Anecdotal evidence suggests that the immunomodulatory drug imiquimod might be a valid therapeutic option in this group of patients. We report the case of a severely immunocompromised HIV-positive patient with resistant facial molluscum contagiosum lesions that responded to topical imiquimod. The response to therapy and the possible implications for pathogenesis are discussed.

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