|Year : 2014 | Volume
| Issue : 3 | Page : 366-368
Molluscum contagiosum: Study of four cases
Shastry Srikanth, Gadda Anandam, B Swapna Kumari, K Sreelatha, Rachakonda Suhela
Department of Pathology, Prathima Institute of Medical Sciences, Karimnagar, Andhra Pradesh, India
|Date of Web Publication||18-Mar-2014|
Department of Pathology, Prathima Institute of Medical Sciences, Karimnagar, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Molluscum contagiosum (MC) is an infection of skin caused by Poxvirus and usually affects any part of the body as pearly pink umbilicated lesion. Immunocompromised patients are more easily prone for this viral infection. Here, we present four cases of MC affecting various locations in the body.
Keywords: Ear lobule in human immunodeficiency virus patient, molluscum contagiosum, rectal region
|How to cite this article:|
Srikanth S, Anandam G, Kumari B S, Sreelatha K, Suhela R. Molluscum contagiosum: Study of four cases. Med J DY Patil Univ 2014;7:366-8
| Introduction|| |
Molluscum contagiosum (MC) is a common, self-limiting viral disease of the skin and mucous membranes. It was first described by Bateman.  The mature virion is a brick-shaped particle measuring 150 nm × 350 nm.  It has a usual incubation period of 14-50 days. 
It is a skin infection caused by Poxvirus and affects otherwise healthy children with a peak incidence between 2 years and 4 years. It is transmitted through direct contact with infected people, fomites, and autoinoculation. Clinically, it usually presents with single or multiple, pale, waxy, and umbilicated nodule on eyelid margins. It may be associated with follicular conjunctivitis with mild mucoid discharge. However, in immunosupressed patients multiple eyelid margin lesions and bulbar nodules are seen. If untreated molluscum lesions may lead to follicular conjunctivitis, epithelial keratitis, pannus, and patients may suffer from reduced vision.
Poor living conditions also warrant the discussion of another common entity.
| Case Report|| |
A retrospective and prospective study was carried out for a period of 9 months on all the clinically diagnosed cases of MC. All four cases were referred from Dermatology Department. Detailed clinical history, family history, and personal history were taken. Out of the four cases, MC was presented on the right ear lobule, rectal polyp, over face and left eyelid. Among these cases, two cases, that is from rectal polyp and from ear lobule patients were found to be human immunodeficiency virus (HIV) positive.
| Discussion|| |
MC virus causes a benign viral infection that is largely (if not exclusively) a disease of human. This virus causes characteristic skin lesions consisting of single or, more often, multiple, rounded, dome-shaped, pink, waxy papules that is 2-5 mm (rarely up to 1.5 cm in the case of a giant molluscus) in the diameter. The papules are umbilicated and contain a caseous plug. Bateman first described the disease in 1817, and Paterson demonstrated its infectious nature in 1841. In 1905, Juliusburg proved its viral nature. Infection follows contact with infected persons or contaminated objects, but the extent of epidermal injury necessary is unknown. Lesions may spread by autoinoculation.
In the present study, out of the four cases two cases were HIV positive both are male patients. Patient with swelling over ear lobule is a 27-year-old male patient and he is a known case of HIV from past 2 years. We were able to detect the MC lesion over his anterior chest wall also. The lesions from the ear lobule was excised and sent for histopathology. We reported it as inverted papilloma with MC infection. Microscopically show multiple molluscum bodies (up to 100) and the epidermis is hyper plastic, hypertrophied.
It extends into dermis and projects above skin surface. Eosinophilic viral inclusion bodies, that is, Henderson Peterson or molluscum bodies become more prominent as cells move upward from basal layer to stratum corneum [Figure 1] and [Figure 2]. Second case in our study is also a HIV positive male patient of 37 years. He presented with fever and a growth in the anorectal region from past 5 months. The rectal polyp was excised and was diagnosed MC involving rectal region [Figure 3]. MC lesions are seen in 10-20% of acquired immunodeficiency syndrome patients. 
|Figure 1: Section showing hyperplastic stratifi ed squamous epithelium thrown into inward papillay foldings along with plenty of molluscum bodies which are intracytoplasmic eosinophilic inclusions (H and E, ×4)|
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|Figure 2: Section showing hyperplastic stratifi ed squamous epithelium with plenty of molluscum bodies (H and E, ×10)|
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|Figure 3: Sections showing hyperplastic squamous epithelium along with intracytoplasmic eosinophilic molluscum bodies (H and E, ×10)|
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Other two cases include 18-year-old male patient with a history of multiple small swellings over the face [Figure 4] and the other was a 5-year-old child with a history of small umbilicated swelling over left eyelid. Both cases were diagnosed MC histopathologically.
|Figure 4: Section showing acanthotic stratifi ed squamous epithelium with many intracytoplamic eosinophilic ovoid molluscum bodies (H and E, ×10 and ×40)|
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Lesions of MC in healthy immunocompetent patients may occur at any part of the body including face, trunk, and limbs. Sexually, active adults have lesions usually on the genitalia, pubis, and inner thigh, rarely on the face and scalp.
Histopathologic section of the biopsy in all the cases revealed inverted lobules of hyperplastic, acanthotic squamous epithelium arranged in the lobulated pattern. The centers of these bulbous structures are filled with enlarged, altered keratinocytes with eosinophilic viral inclusions referred to as Henderson and Paterson inclusion bodies. The inclusion bodies are the result of a virally induced transformation process. Initially, the small virion particle is formed in the cytoplasm of the epithelial cells above the basal layer. These eosinophilic particles grow in size as they progress toward the granular cell layer causing compression of the nucleus to the periphery of the infected epithelial cells. An easy method to remove the lesions is eviscerating the core with an instrument such as a scalpel, sharp tooth pick, edge of a glass slide or any other instrument capable of removing the umbilicated core. One of the most common, quick, efficient methods of treatment is cryotherapy. 
Complications of MC include irritation, inflammation, and secondary infections. Lesions on eyelids may be associated with the follicular or papillary conjunctivitis. Bacterial superinfection may occur but is seldom of clinical significance.
Cellulitis is an unusual complication of MC in patients who are HIV infected. Secondary infection with Staphylococcus aureus has resulted in abscess formation, whereas Pseudomonas aeruginosa n cause necrotizing cellulitis. 
The prognosis in MC is generally excellent because the disease is usually benign and self-limited. Spontaneous resolution generally occurs by 18 months in immunocompetent individuals; however, lesions have been reported to persist for as long as 5 years. In healthy patients, treatments are usually effective, although lesions can be disfiguring and may produce anxiety in the patient, family, and daycare facility or school. 
Recurrences occur in as many as 35% of patients after initial clearing. The significance of these recurrences is unknown. They may represent reinfection, exacerbation of ongoing disease, or new lesions arising after a prolonged latent period.
The disease often becomes generalized in patients who are infected with HIV or are otherwise immunocompromised. A direct correlation has been found between increasing severity of the disease and lower CD4 counts. The duration of infection is uncertain in populations with HIV infection and in populations that are otherwise immunocompromised (e.g., patients who have undergone renal transplant), because MC may not be self-limiting in these cases.
MC is generally, a benign and self-limited infection. For the most part, morbidity is caused by temporary adverse cosmetic results. Morbidity is higher in immunocompromised patients because they tend to have more lesions and more widespread infection. Most lesions resolve with no permanent residual skin defect; however, occasional lesions may produce a slightly depressed scar. This may represent deeper skin damage in lesions that were particularly inflammatory or secondarily infected. Involvement of the margin of the eyelids may produce keratoconjunctivitis. No mortality has been associated directly with the MC virus. Highly active anti-retroviral therapy regime in an HIV patient can prevent the MC and simple excision followed by antiviral therapy can manage MC.
We present this study to educate the modes of spread, preventive measures and the various locations affected by MC.
| References|| |
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]