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doi:10.1111/jpc.12530

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Giant eyelid molluscum contagiosum presenting as preseptal cellulitis Preseptal cellulitis can be caused by multiple factors, common ones being paranasal sinusitis, upper respiratory tract infection, acute or chronic otitis, dental abscess and ocular trauma.1 The presenting clinical signs are swelling, pain and redness of the peri-orbital tissues. A 5-year-old girl was admitted to us with complaints of painful swelling and erythema of the left upper eyelid with a nodular lesion. The child had tested negative for HIV-1 by enzyme-linked immunosorbent assay, and this was confirmed by Western blot test. She had multiple whitish nodules of molluscum contagiosum over the left lower eyelid and around the mouth. The lesions varied in size between 1 and 6 mm in diameter. Ocular examination revealed a swollen upper eyelid with erythema, warmth and tenderness on the left side and multiple smaller molluscum lesions on the lower eyelid margin (Fig. 1). The conjunctiva was mildly congested, with follicular reaction. One molluscum lesion was excised under local anaesthesia, and on light microscopic study, this lesion showed acanthotic epithelium. Within the epithelium, round and oval eosinophilic intracytoplasmic inclusion bodies consistent with molluscum bodies were detected. The child was given sulbactam/ ampicillin for 10 days. In addition, ciprofloxacin eye ointment was administered twice daily in the left eye. After 2 weeks, lid oedema subsided. A giant molluscum contagiosum was detected over the upper eyelid. Molluscum contagiosum occurs world-wide but is more prevalent in tropical areas. Children more typically develop lesions at multiple sites, most commonly on the face, trunk and extremities. Extensive molluscum contagiosum in the eyelids has been reported in patients with acquired immunodeficiency syndrome (AIDS).2–4 However, bacterial eyelid abscess is a rare condition in the eyes of such patients. Biswas et al. reported a cellulitis and closure of the eyelid with extensive molluscum contagiosum in a 4-year-old boy with AIDS.5 Secondary infection in the molluscum lesions in other parts of the body has been reported. Boudreau et al. reported the presence of Staphylococcus aureus, cytomegalovirus and acid-fast bacilli in a patient who presented with multiple skin lesions, clinically suggestive of molluscum contagiosum.6 Preseptal cellulitis is more prevalent in children less than 10 years old. The most important pathogens causing preseptal cellulitis are Staphylococcus species, which are usually sensitive to first-line antibiotics. Because early diagnosis with prompt medical and surgical intervention lead to an excellent prognosis, adequately treated cellulitis in the orbital area rarely results in significant morbidity today. We emphasise that molluscum contagiosum should be included in the differential diagnosis of an eyelid infection, particularly in children.

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Fig. 1 Swollen and erythematous upper left eyelid and multiple small molluscum lesions on the lower eyelid margin.

References 1 Chaudhry IA, Shamsi FA, Elzaridi E, Al-Rashed W, Al-Amri A, Arat YO. Inpatient preseptal cellulitis: experience from a tertiary eye care centre. Br. J. Ophthalmol. 2008; 92: 1337–41. 2 Kohn SR. Molluscum contagiosum in patients with acquired immunodeficiency. Arch. Ophthalmol. 1987; 105: 458. doi:10.1001/archopht.1987.01060040028015. 3 Robinson MR, Udell IJ, Garber PF, Perry HD, Streeten BW. Molluscum contagiosum of the eyelids in patients with acquired immunodeficiency syndrome. Ophthalmology 1992; 99: 1745–7. 4 Charles NC, Friedberg DN. Epibulbar molluscum contagiosum in acquired immune deficiency syndrome. Ophthalmology 1992; 99: 123–36. 5 Biswas J, Therese L, Kumarasamy N, Solomon S, Yesudian P. Lid abscess with extensive molluscum contagiosum in a patient with acquired immunodeficiency syndrome. Indian J. Ophthalmol. 1997; 45: 234–6. 6 Boudreau S, Hines HC, Hood AF. Dermal abscesses with Staphylococcus aureus, cytomegalovirus and acid-fast bacilli in a patient with acquired immunodeficiency syndrome (AIDS). J. Cutan. Pathol. 1988; 15: 53–7.

Associate Professor Kemal Örnek1 Assistant Professor Zafer Onaran1 Professor Mukadder Koçak2 Departments of 1Ophthalmology and 2Dermatology, School of Medicine Kırıkkale University Kırıkkale Turkey

Journal of Paediatrics and Child Health 50 (2014) 1036 © 2014 The Authors Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

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