Recurrent giant molluscum contagiosum immune reconstitution inflammatory syndrome (IRIS) after initiation of antiretroviral therapy in an HIV-infected man

Drain, Paul K.; Mosam, Anisa; Gounder, Lilishia; Gosnell, Bernadett I.; Manzini, Thandekile C.; Moosa, Mahomed-Yunus S.

doi:10.1177/0956462413497702

Cited by 10 publications

(5 citation statements)

References 18 publications

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“…Indeed, in some individuals, molluscum contagiosum may serve as the first clinical indicator of HIV infection [30,35,37]. [30][31][32]34,38]. They can be solitary [32,36] or multiple [30,31,[33][34][35]37].…”

Section: Discussionmentioning

confidence: 99%

“…In most HIV-positive patients, molluscum contagiosum resolves after highly-active antiretroviral therapy (HAART) is initiated [31,37]. However, albeit rarely, molluscum contagiosum may occur as a manifestation of immune reconstitution inflammatory syndrome (IRIS) following the administration of antiretroviral treatment [38]. Alternatively, other antiviral agents (such as topical cidofovir [34]) have been used.…”

Section: Discussionmentioning

confidence: 99%

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Molluscum contagiosum of the eyelid: case report in a man receiving methotrexate and literature review of molluscum contagiosum in patients who are immunosuppressed secondary to methotrexate or HIV infection

Beutler

Cohen²

2016

Dermatology Online Journal

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Background: Molluscum contagiosum is a benign viral infection of the skin. Lesions typically present as dome-shaped, fleshcolored, umbilicated papules that range in size from 1 to 5 millimeters in diameter. They are usually asymptomatic, but can become tender or pruritic. Children and immunocompromised adults, including individuals being treated with immunosuppressive drugs, are most susceptible to infection. Single or multiple lesions most commonly appear on the extremities, face, genitals, and trunk. However, albeit rarely, molluscum contagiosum may also develop at other sites, including the eyelids.Purpose: We describe the clinical and pathologic findings of a man who developed molluscum contagiosum of the eyelid while receiving methotrexate. We also review the characteristics of other patients with molluscum contagiosum acquired either during treatment with methotrexate or associated with human immunodeficiency virus (HIV) infection and summarize the unusual sites of presentation for the viral lesions in these individuals.Materials and methods: The features of a man receiving methotrexate who developed molluscum contagiosum of the eyelid are presented. Using PubMed, the following terms were searched and relevant citations assessed: adalimumab, contagiosum, Enbrel, etanercept, Humira, infliximab, methotrexate, molluscum, Remicade, TNF alpha, and tumor necrosis factor alpha. In addition, the literature on methotrexate treatment and molluscum contagiosum is reviewed.Results: Several small papules were observed on the eyelid of a 24-year-old man who had been receiving methotrexate and adalimumab (Humira) for the treatment of Crohn disease. The lesions were removed by shave biopsy. Microscopic examination revealed epidermal hyperplasia composed of keratinocytes filled with large eosinophilic intracytoplasmic inclusions. Based on correlation of the clinical presentation and histopathologic findings, a diagnosis of molluscum contagiosum was established. The patient applied mupirocin 2% ointment to the biopsy sites, which subsequently healed without complication or recurrence. Conclusion:Molluscum contagiosum is a benign viral papular eruption that frequently affects children and immunocompromised adults. Patients treated with immunosuppressive agents, such as methotrexate, have a heightened risk of developing molluscum contagiosum lesions. It remains to be determined whether adjunct therapy with a tumor necrosis factor alpha inhibitor increases the risk of this viral infection. Diagnosis can usually be established by clinical presentation, although a biopsy is sometimes required to exclude other conditions. Molluscum contagiosum is generally self-limiting and often resolves spontaneously within 18 months. However, topical (cantharidin) or locally destructive (curettage, cryotherapy, and/or laser) therapy may be indicated for patients who are concerned about persistent lesions and for children who are particularly susceptible to autoinoculation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Molluscum contagiosum of the eyelid: case report in a man receiving methotrexate and literature review of molluscum contagiosum in patients who are immunosuppressed secondary to methotrexate or HIV infection

Beutler

Cohen²

2016

Dermatology Online Journal

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“…1,8 Individu imunokompromais, termasuk orang dengan HIV/AIDS (ODHA) dan penerima transplantasi organ ataupun sedang dalam terapi imunosupresan, lebih berisiko terinfeksi MK. 1,9 ETIOPATOGENESIS Virus moluskum kontagiosum (VMK) adalah poxvirus berbentuk lonjong dengan DNA untai ganda linear. 1,2,5 Terdapat 4 subtipe VMK, yaitu VMK 1, VMK II, VMK III, dan VMK IV.…”

Section: Pendahuluanunclassified

Diagnosis dan Tata Laksana Moluskum Kontagiosum

Anggawirya

2022

Cermin Dunia Kedokteran

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Moluskum kontagiosum adalah penyakit kulit yang disebabkan oleh virus. Penyakit ini ditemukan di seluruh dunia dan paling banyak menyerang anak-anak. Penularan terjadi melalui kontak langsung ataupun tidak langsung. Diagnosis melalui identifikasi lesi khas moluskum kontagiosum; dermoskopi dan pemeriksaan histopatologi memegang peranan pada kasus sulit. Penatalaksanaan yang diberikan terutama adalah kuretase, krioterapi, dan cantharidin pada anak-anak. Moluskum kontagiosum dapat sembuh secara spontan. Moluscum contagiosum is a skin disease which caused by molluscum contagiosum virus. Molluscum contagiosum occurs worldwide and is more frequent in children. Transmission is mainly by direct or indirect contact. Diagnosis is based on distinguishing characteristics of the lesions, but dermoscopy and histopathology examinations can be helpful in difficult cases. Treatment consists mainly of curettage, cryotherapy, and cantharidin in children. Molluscum contagiosum can heal spontaneously.

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“…Although combined antiretroviral therapy (cART) usually suffices to resolve the lesions of MC, sudden appearance of giant MC may be provoked by an augmented immune response. [3] We herein present such a probable case of the immune reconstitution inflammatory syndrome (IRIS).…”

Section: Introductionmentioning

confidence: 99%

Giant molluscum contagiosum unmasked probably during an immune reconstitution inflammatory syndrome

Gupta

Ghogre

Misra

et al. 2018

Indian J Sex Transm Dis

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Restoration of specific immune responses by combined antiretroviral therapy (cART) in patients infected with human immunodeficiency virus (HIV) may paradoxically cause an inflammatory reaction known as immune reconstitution inflammatory syndrome (IRIS). We report the emergence of giant nodules of molluscum contagiosum (MC) on the face and thighs 2 months after initiation of cART in a 45-year-old male patient with acquired immune deficiency syndrome. To the best of our knowledge, our report describes the first case of MC probably unmasked during IRIS from India.

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Recurrent giant molluscum contagiosum immune reconstitution inflammatory syndrome (IRIS) after initiation of antiretroviral therapy in an HIV-infected man

Cited by 10 publications

References 18 publications

Molluscum contagiosum of the eyelid: case report in a man receiving methotrexate and literature review of molluscum contagiosum in patients who are immunosuppressed secondary to methotrexate or HIV infection

Molluscum contagiosum of the eyelid: case report in a man receiving methotrexate and literature review of molluscum contagiosum in patients who are immunosuppressed secondary to methotrexate or HIV infection

Diagnosis dan Tata Laksana Moluskum Kontagiosum

Giant molluscum contagiosum unmasked probably during an immune reconstitution inflammatory syndrome

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