Question | Discussion | References | CME Credit

Updated December 22, 2010

Case 5: Molluscum Contagiosum

Author: David H. Spach, MD

A 48-year-old HIV-infected man comes in for routine care and evaluation of skin lesions on his face. His most recent labs showed a CD4 count of 38 cells/mm3 and HIV RNA of 87,000 copies/ml. He is an active intravenous heroin user and has not been able to stay on antiretroviral therapy. The patient describes a 2-3 month history of persistent papules on his face that have gradually increased in number and size (Figure 1). The lesions have not responded to over-the-counter acne therapies. A clinical diagnosis of molluscum contagiosum is made.

Which of the following statements is TRUE regarding molluscum contagiosum in HIV-infected persons?

A The diagnosis of molluscum contagiosum in this patient is probably wrong because molluscum lesions almost never develop on the face of HIV-infected persons.
B Molluscum contagiosum is caused by human papillomavirus (HPV) type 6.
C Although molluscum contagiosum can result in disfiguring skin lesions in HIV-infected persons with advanced immune suppression, these individuals do not develop systemic complications from molluscum.
D Recent data have shown that valacyclovir (Valtrex) is a highly effective treatment for molluscum in HIV-infected persons.

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    Figure 1. Multiple Chronic Facial Lesions

    Multiple chronic papular lesions on the face of an HIV-infected man with advanced HIV-related immune suppression.

    Figure 1