Atypical molluscum contagiosum infection in an HIV-infected patient

A 43-year-old man, who was an intravenous drug abuser from 1978 to 1988, was referred to our STD & AIDS Center in October 1995 with flesh-colored nodules of the foreskin. He was confirmed to be seronegative in February 1989, and the first positive human immunodeficiency virus (HIV) serology was documented in October 1989. At that time, the CD4+ count was 114/mm³ and anti-retroviral therapy was therefore initiated and prolonged until October 1995. Within the last 4 months, the patient progressively lost weight (13 kg) and suffered from recurrent oral candidiasis, cytomegalovirus (CMV) retinitis, and severe oral herpes simplex virus (HSV) infection. Shortly afterwards the dermatologic lesions appeared. At this time, the CD4+ count had decreased to 8/mm³. Examination revealed nodules distributed over the external and internal linings of the foreskin, some isolated and some grouped, but individually well defined. These lesions, of the same color as the surrounding skin or slightly erythematous, were of varying sizes ranging from 0.5 to 1 cm in diameter, sessile, globous, coated with a keratotic epidermal layer, not shiny, hard-elastic, non-tender at compression, and without evident central umbilication, mimicking condylomata acuminata (Fig. 1). Upon squeezing, no discharge could be seen. The source of this infection was not identified as the patient denied sexual contact for the previous year.
A three-lesions biopsy showed the characteristic histologic features of molluscum contagiosum (MC). The dermis appeared indented by multiple, closely packed, lobules of proliferating epithelium (Figs 2 and 3). The infected keratinocytes contained intracytoplasmatic inclusions, the so-called molluscum bodies displacing the nucleus and enlarging the infected cells.