Diagnosis: Molluscum Contagiosum
A 31-year-old male with HIV presenting with extensive dome-shaped papules with central umbilication on the face, neck, and trunk.
Shiny, dome-shaped, skin-colored to pinkish papules ranging from 2-8mm with characteristic central umbilication (dell). Lesions are most numerous on the face, beard area, and neck, with scattered papules on the trunk and axillae. Some larger lesions (giant molluscum, up to 15mm) present on the cheeks. No groin or genital involvement.
Lesions first appeared 4 months ago and have been spreading rapidly. Patient diagnosed with HIV 2 years ago but non-adherent to antiretroviral therapy. CD4 count 85 cells/mm3. Previous attempts at self-treatment with over-the-counter salicylic acid unsuccessful.
Urgent reinitiation of antiretroviral therapy in coordination with infectious disease. Cryotherapy with liquid nitrogen to accessible lesions in staged sessions. Curettage of larger lesions under local anesthesia. Topical imiquimod 5% cream for residual lesions three times weekly. Immune reconstitution expected to significantly reduce disease burden. Monitoring for immune reconstitution inflammatory syndrome (IRIS).
Tags: viral, poxvirus, immunocompromised, HIV, cryotherapy