|Year : 2015 | Volume
| Issue : 1 | Page : 54-56
Iqbal M Banyameen, Jain K Atul, Kambale J Tushar
Department of Pathology, Dr. D.Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra, India
|Date of Web Publication||8-Jan-2015|
Iqbal M Banyameen
Department of Pathology, Dr. D.Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
Molluscum contagiosum (MC) is a common childhood viral infection caused by a large, double-stranded deoxyribonucleic acid poxvirus. A 22-year-old male patient presents with an infected lesion on his right pinna since the last 1 month, which oozed out a cheesy material on pressing and clinically a sebaceous cyst was suspected, However, on careful histopathological examination a diagnosis of MC was made.
Keywords: Deoxyribonucleic acid pox virus, inclusion bodies, molluscum contagiosum
|How to cite this article:|
Banyameen IM, Atul JK, Tushar KJ. Molluscum contagiosum. Med J DY Patil Univ 2015;8:54-6
| Introduction|| |
Molluscum contagiosum (MC) is a common childhood viral infection of squamous epithelia caused by a large double-stranded deoxyribonucleic acid (DNA) poxvirus which is an unclassified member of the Poxviridae family.  It generally appears on skin as waxy, dome-shaped papules.  MC virus causes a benign viral infection that is largely (if not exclusively) a disease of humans. MC 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 diameter. The papules are umbilicated and contain a caseous plug. 
| History|| |
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. Three distinct disease patterns are observed in three different patient populations: Children, adults who are immunocompetent, and patients who are immunocompromised (children or adults). The prognosis and therapy are different for each of these groups.
| Case Report|| |
A 22-year-old male patient present with an infected lesion on his left pinna since the last 1 month which oozed out a cheesy material on pressing [Figure 1]. Patient was febrile and complaining of pain left side of whole face. A provisional clinical diagnosis of sebaceous cyst was made. A baseline investigation (hemogram) was done which was showing hemoglobin 13.5 g/dl and mild leukocytosis (total leukocyte count: 13,200/dl). Patient was immunologically competent (negative for human immunodeficiency virus [HIV], hepatitis B virus surface antigen, and hepatitis C virus). Systemic examination was within normal limits and no apparent abnormality was detected.
Treatment Given Before Surgery
Patient was kept on topical as well as oral antibiotics for 1 week, but the lesion didn't show any regression and a biopsy was advised.
| Histopathology|| |
The histopathological examination of the hematoxilin and eosin stained slides of the specimen revealed the presence of cells which have cytoplasm filled with eosinophilic granular inclusions which has displaced the nucleus of the cells to the periphery and also enlarged the cells, these features are consistent with that of a MC [Figure 2] and [Figure 3].
| Discussion|| |
The MC virus replicates in the cytoplasm of epithelial cells, producing cytoplasmic inclusions and enlargement of infected cells. This virus infects only the epidermis. Infection follows contact with infected persons or contaminated objects, but the extent of necessary epidermal injury is unknown.  The initial infection seems to occur in the basal layer, and the incubation period is usually 2-7 weeks. This is suggested by the fact that, although viral particles are noted in the basal layer, viral DNA replication and the formation of new viral particles do not occur until the spindle and granular layers of the epidermis are involved. Infection may be accompanied by a latent period of as long as 6 months. MC virus is an unclassified member of the Poxviridae family. It cannot be grown in tissue culture or eggs; it has been grown in human foreskin grafted to athymic mice, but has not been transmitted to other laboratory animals.  Through restrictive endonuclease analysis of the genomes of isolates, MC virus Type's I-IV has been identified. In a study of 147 patients, MC virus I caused 96.6% of infections, and MC virus II caused 3.4%; however, no relationship was observed between virus type and lesional morphology or anatomical distribution.  MC viruses III and IV are rare. In patients with HIV infection, MC virus II causes most infections (60%). 
Molluscum contagiosum may be randomly associated with other lesions, such as epidermal cysts, nevocellular nevi, sebaceous hyperplasias, and Kaposi sarcoma. Pseudocystic MC, giant MC, and MC associated with other lesions are responsible for frequent clinical misdiagnoses. 
Verruca vulgaris, myrmecia type: The large eosinophilic keratohyaline granules of human papillomavirus infection have been mistaken for molluscum. The inclusions are usually granular, and the myrmecia-type warts typically occur on nonhair-bearing acral sites (an extremely rare site for MC).  Differential diagnoses to consider in patients with AIDS include the following, cutaneous Cryptococcus.  Cutaneous Cryptococcus presents as molluscum like eruptions (on the face, it often has a very dramatic appearance); the patient may have few or no other symptoms associated with cryptococcal meningitis. 
| Treatment of Molluscum Contagiosum|| |
In healthy patients, MC is generally self-limited and heals spontaneously after several months. Individual lesions are seldom present for more than 2 months. Although, treatment is not required, it may help to reduce autoinoculation or transmission to close contacts and improve clinical appearance. 
Some of the common treatment modalities available are:
- Freezing the bumps, called cryotherapy or cryosurgery.
- Scraping off the bumps, called curettage.
- Putting a chemical on the bumps, like cantharidin or potassium hydrochloride.
- Using liquids or creams, such as those used to treat warts.
- Children may not need treatment because MC usually goes away on its own.
In HIV-infected patients, molluscum is difficult to eradicate and lesions often recur, particularly if immune suppression persists. Effective antiretroviral therapy may achieve resolution of lesions or significant improvement in the extent or appearance of molluscum.  In this case, curettage was done and patient was advised antibiotics for a week and on follow-up patient had recovered fully.
| References|| |
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[Figure 1], [Figure 2], [Figure 3]