involving the right upper eyelid. A large, single, umbilicated lesion devel¬ oped, which proved through the biopsy to be molluscum contagiosum. We found only one other case report of a similar presentation; it was on the lower eyelid of a healthy 3-year-old
child.1 Molluscum should be considered in the differential diagnosis of large, sol¬ itary, rapidly growing eyelid lesions along with keratoacanthoma, seba¬ ceous
Fig 2.—Histopathologic features of biopsy specimen taken from lesion on right upper eyelid showing typical intracytoplasmic inclu¬ sions (arrowheads) (original magnification X100).
3 \m=x\2-cm firm, tender, elevated lesion adjacent to the original nodule, which had a deep central encrusted cavity (Fig 1, bottom). The remainder of her examination results remained unchanged. An incisional biopsy was performed of the new lesion, and both bacterial and fungal cultures were ob¬ a
Fig 1.—Top, Initial appearance of right upper eyelid. Bottom, Eyelid 1 week later.
Giant Molluscum Contagiosum
Following Splenectomy The cutaneous lesions of molluscum contagiosum are typically small, multiple, umbilicated papules. We report herein a case of a periocular molluscum infection that appeared as a large, solitary, rapidly growing lesion of the upper
eyelid.
Report of a Case.\p=m-\A25-year-old white presented with a 1-month history of an elevated erythematous nodule on the right upper eyelid. She complained of mild periocular pain. The examination revealed a best corrected visual acuity of 20/20 OU. A 1 \m=x\1-cm, firm, tender, elevated, nonumbilicated nodule was present in the right upper eyelid (Fig 1, top). The eyelid skin was erythematous and mildly edematous, but intact. There were no conjunctival follicles or keratitis. The remainder of the ophwoman
thalmic examination results were normal. The patient received oral erythromycin
therapy.
One week later, the patient returned with
tained. The lesion time. The biopsy
was
also curetted at this
specimen demonstrated typical intracytoplasmic inclusions of mol¬ luscum contagiosum (Fig 2). Antibiotic therapy was discontinued, and the right upper eyelid healed during the next 2 months without additional therapy. Only minimal scarring occurred. Three months prior to her initial presen¬ tation, the patient underwent a splenectomy. The operation was performed for pancytopenia secondary to hypersplenism from a presumed viral infection. All white blood cell counts were normal postoperatively, yet the patient developed a recurrent suba¬ cute bacterial endocarditis along with her atypical molluscum infection. No immunodeficient conditign has been diagnosed. The patient tested negative for human immu¬ nodeficiency virus. Comment.—When molluscum
con¬
tagiosum involves the eyelid skin, the lesions are usually small, firm, waxy, umbilicated papules. Follicular con¬ junctivitis and superficial keratitis may occur secondarily. The diagnosis is often made from clinical examina¬ tion because of the characteristic cu¬ taneous lesions. Our patient presented with a solitary, nonumbilicated nodule
cysts, foreign-body granuloma,
and chalazion. An incisional biopsy will help make a proper diagnosis and prevent unnecessarily large excisions that could compromise the eyelids. Many viruses cause opportunistic infections in immunocompromised hosts. Molluscum, a double-stranded DNA poxvirus, has been associated with unusual clinical manifestations in patients with acquired immunode¬ ficiency syndrome.2 An uncontrollable disseminated infection was also re¬ ported in a patient with selective im-
munoglobulin
M
deficiency.3 Splenec-
tomy decreases the body's resistance to infection from
encapsulated bacte¬ rial organisms. However, no decreased viral immunity occurs. Our patient's atypical giant lesion may have oc¬ curred as a result of some immunode¬ ficiency from splenectomy, or these conditions may be totally unrelated. To our knowledge, no unusual mollus¬ cum infections have been documented in patients following splenectomy. Still, we recommend an evaluation for known conditions that decrease the body's resistance to infection when unusual manifestations of molluscum contagiosum
occur.
John V. Linberg, MD William K. Blaylock, MD Morgantown, WVa
1. Van der Meer Maastricht BCJ, Gomperts CE. Molluscum contagiosum giganteum. Am J Ophthalmol. 1950;33:965-967. 2. Katzman M, Carey JT, Elmets CA, Jacobs GH, Lederman MM. Molluscum contagiosum and the acquired immunodeficiency syndrome: clinical and immunological details of two cases. Br J Dermatol. 1987;116:131-138. 3. Mayumi M, Yamaoka K, Tsutsui T, et al. Selective immunoglobulin M deficiency associated with disseminated molluscum contagiosum. EurJ Pediatr. 1986;145:99-103.
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child.1 Molluscum should be considered in the differential diagnosis of large, sol¬ itary, rapidly growing eyelid lesions along with keratoacanthoma, seba¬ ceous
Fig 2.—Histopathologic features of biopsy specimen taken from lesion on right upper eyelid showing typical intracytoplasmic inclu¬ sions (arrowheads) (original magnification X100).
3 \m=x\2-cm firm, tender, elevated lesion adjacent to the original nodule, which had a deep central encrusted cavity (Fig 1, bottom). The remainder of her examination results remained unchanged. An incisional biopsy was performed of the new lesion, and both bacterial and fungal cultures were ob¬ a
Fig 1.—Top, Initial appearance of right upper eyelid. Bottom, Eyelid 1 week later.
Giant Molluscum Contagiosum
Following Splenectomy The cutaneous lesions of molluscum contagiosum are typically small, multiple, umbilicated papules. We report herein a case of a periocular molluscum infection that appeared as a large, solitary, rapidly growing lesion of the upper
eyelid.
Report of a Case.\p=m-\A25-year-old white presented with a 1-month history of an elevated erythematous nodule on the right upper eyelid. She complained of mild periocular pain. The examination revealed a best corrected visual acuity of 20/20 OU. A 1 \m=x\1-cm, firm, tender, elevated, nonumbilicated nodule was present in the right upper eyelid (Fig 1, top). The eyelid skin was erythematous and mildly edematous, but intact. There were no conjunctival follicles or keratitis. The remainder of the ophwoman
thalmic examination results were normal. The patient received oral erythromycin
therapy.
One week later, the patient returned with
tained. The lesion time. The biopsy
was
also curetted at this
specimen demonstrated typical intracytoplasmic inclusions of mol¬ luscum contagiosum (Fig 2). Antibiotic therapy was discontinued, and the right upper eyelid healed during the next 2 months without additional therapy. Only minimal scarring occurred. Three months prior to her initial presen¬ tation, the patient underwent a splenectomy. The operation was performed for pancytopenia secondary to hypersplenism from a presumed viral infection. All white blood cell counts were normal postoperatively, yet the patient developed a recurrent suba¬ cute bacterial endocarditis along with her atypical molluscum infection. No immunodeficient conditign has been diagnosed. The patient tested negative for human immu¬ nodeficiency virus. Comment.—When molluscum
con¬
tagiosum involves the eyelid skin, the lesions are usually small, firm, waxy, umbilicated papules. Follicular con¬ junctivitis and superficial keratitis may occur secondarily. The diagnosis is often made from clinical examina¬ tion because of the characteristic cu¬ taneous lesions. Our patient presented with a solitary, nonumbilicated nodule
cysts, foreign-body granuloma,
and chalazion. An incisional biopsy will help make a proper diagnosis and prevent unnecessarily large excisions that could compromise the eyelids. Many viruses cause opportunistic infections in immunocompromised hosts. Molluscum, a double-stranded DNA poxvirus, has been associated with unusual clinical manifestations in patients with acquired immunode¬ ficiency syndrome.2 An uncontrollable disseminated infection was also re¬ ported in a patient with selective im-
munoglobulin
M
deficiency.3 Splenec-
tomy decreases the body's resistance to infection from
encapsulated bacte¬ rial organisms. However, no decreased viral immunity occurs. Our patient's atypical giant lesion may have oc¬ curred as a result of some immunode¬ ficiency from splenectomy, or these conditions may be totally unrelated. To our knowledge, no unusual mollus¬ cum infections have been documented in patients following splenectomy. Still, we recommend an evaluation for known conditions that decrease the body's resistance to infection when unusual manifestations of molluscum contagiosum
occur.
John V. Linberg, MD William K. Blaylock, MD Morgantown, WVa
1. Van der Meer Maastricht BCJ, Gomperts CE. Molluscum contagiosum giganteum. Am J Ophthalmol. 1950;33:965-967. 2. Katzman M, Carey JT, Elmets CA, Jacobs GH, Lederman MM. Molluscum contagiosum and the acquired immunodeficiency syndrome: clinical and immunological details of two cases. Br J Dermatol. 1987;116:131-138. 3. Mayumi M, Yamaoka K, Tsutsui T, et al. Selective immunoglobulin M deficiency associated with disseminated molluscum contagiosum. EurJ Pediatr. 1986;145:99-103.
Downloaded From: http://archopht.jamanetwork.com/ by a University of Arizona Health Sciences Library User on 06/09/2015
