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Ortega V, Lovell R, Vanegas Acosta D. Eyelid Molluscum Contagiosum: A Sign of Advanced HIV Infection. Cureus 2024; 16:e53783. [PMID: 38465055 PMCID: PMC10923586 DOI: 10.7759/cureus.53783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/12/2024] Open
Abstract
HIV infection can present with dermatologic pathologies, and molluscum contagiosum in the eyelid is a specific sign often related to advanced HIV. Herein, we present the case of an adult patient with eyelid molluscum contagiosum that had been present for the last five years. Despite previous healthcare evaluation, the patient was not tested for HIV infection until presenting to our healthcare facility. The patient was diagnosed with AIDS. Our case highlights the importance of recognizing indirect signs of immunosuppression and the need to promptly order an HIV test. Additionally, we want to emphasize the importance of raising awareness about routine HIV testing, aiming to reduce the social stigma surrounding this test.
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Affiliation(s)
| | - Roger Lovell
- Infectious Diseases, Piedmont Athens Regional Medical Center, Athens, USA
| | - Diego Vanegas Acosta
- Medicine, College of Medicine, University of Florida Shands Hospital, Gainesville, USA
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2
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Achdiat PA, Andiani S, Hindritiani R, Gondokaryono SP, Nuzuliyah G, Usman HA, Maharani RH. Molluscum Contagiosum in HIV Patient Treated with 20% Topical Glycolic Acid After Resistance with Topical Tretinoin. Clin Cosmet Investig Dermatol 2023; 16:2749-2755. [PMID: 37794945 PMCID: PMC10546996 DOI: 10.2147/ccid.s423304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023]
Abstract
Molluscum contagiosum (MC) is a benign papular skin infection caused by Molluscum contagiosum virus (MCV). Over the past 30 years, the incidence of MK has continued to increased association with sexually transmitted infections and human immunodeficiency virus (HIV) infection. The incidence of MC in HIV patients is quite high at 5-8%. Until now there is no standard therapy used for the treatment of MC in patients with HIV. In HIV patients, anti retro viral therapy (ARV) is the main therapy with several other additional therapies such as cantaridin, chemical peeling agents such as glycolic acid (20-70%) and trichloroacetic acid (20-100%), cryosurgery, electrosurgery, incision, lactic acid, laser surgery, podophyllin, retinoic acid, and urea. There have been no studies regarding the administration of topical 20% glycolic acid in MC patients. We report a case of MC in an HIV patient who was treated with 20% topical glycolic acid after failing treatment with topical tretinoin. The diagnosis was made clinically, cytologically, and histopathologically, a white mass was found on compression of the lesion and Henderson-Paterson bodies. The lesions on the face, arms, and legs were given glycolic acid lotion 20% which was applied once a day at night. The lesions started to show responses to the treatment at week 6th as some of the MC papules became hyperpigmented macules. The side effects of therapy that appeared were itching and hyperpigmentation. Topical 20% glycolic acid can be used for MC therapy with minimal side effects, easy to apply and safe.
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Affiliation(s)
- Pati Aji Achdiat
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Syafira Andiani
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Reti Hindritiani
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Srie Prihianti Gondokaryono
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Gempita Nuzuliyah
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Hermin Aminah Usman
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Padjadjaran – Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Retno Hesty Maharani
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
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3
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Fernando I, K Edwards S, Grover D. British Association for Sexual Health and HIV national guideline for the management of Genital Molluscum in adults (2021). Int J STD AIDS 2022; 33:422-432. [PMID: 35312417 DOI: 10.1177/09564624211070705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This guideline offers recommendations on diagnosis, treatment regimens and health promotion principles needed for the effective management of genital molluscum, including management of the initial presentation and recurrences. The Primary focus of the guideline is on infection which affects the genital area and has a sexual mode of transmission. This is an update to the guideline previously published in this journal in 2014.
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Affiliation(s)
| | - Sarah K Edwards
- GU Medicine, 215332Cambridgeshire Community Services NHS Trust, Bury St Edmunds, UK
| | - Deepa Grover
- GUM/HIV Medicine, 4954Central and North West London NHS Foundation Trust, London, UK
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4
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Fornari M, Cohen J, Birdsong R. AIDS Presenting in an Adolescent Male With Persistent Conjunctivitis and Eye Pain. J Adolesc Health 2021; 68:827-829. [PMID: 33280977 DOI: 10.1016/j.jadohealth.2020.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/15/2020] [Accepted: 10/30/2020] [Indexed: 10/22/2022]
Abstract
An adolescent male with persistent conjunctivitis and an episcleral nodule presented with new-onset focal seizures and headaches. The patient was found to have cotton wool spots and papilledema on retinal examination. He was ultimately diagnosed with HIV retinopathy and AIDS. Ocular manifestations are rare presenting symptoms of AIDS among adolescents in the United States. Ocular disease in pediatric HIV/AIDS patients is most often caused by opportunistic infections. HIV retinopathy, the most common cause of blindness in patients with HIV, is usually a late disease manifestation. It is important for providers caring for adolescents to be aware of the potential ocular manifestations of HIV/AIDS. Teenagers are less likely to be aware of their HIV status and less likely to be tested for HIV, despite high risk exposures, and therefore, universal and routine HIV screening is recommended for all patients.
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Affiliation(s)
- Marci Fornari
- Children's National Health System, Department of Emergency Medicine, Washington, District of Columbia.
| | - Joanna Cohen
- Children's National Health System, Department of Emergency Medicine, Washington, District of Columbia
| | - Richard Birdsong
- Children's National Health System, Department of Ophthalmology, Washington, District of Columbia
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Serin Ş, Bozkurt Oflaz A, Karabağlı P, Gedik Ş, Bozkurt B. Eyelid Molluscum Contagiosum Lesions in Two Patients with Unilateral Chronic Conjunctivitis. Turk J Ophthalmol 2017; 47:226-230. [PMID: 28845328 PMCID: PMC5563552 DOI: 10.4274/tjo.52138] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/27/2016] [Indexed: 12/01/2022] Open
Abstract
Molluscum contagiosum (MC) is a viral infection of the skin and mucosal tissues characterized by skin-colored or transparent round nodules with a dimple or pit in the center. The infection is caused by a DNA poxvirus called the MC virus. Although MC generally occurs in children, it has also been reported in immunocompromised and atopic patients. The virus is transmitted by skin contact or sexual intercourse. The lesions disappear spontaneously within several months in most cases. However, excision, cryotherapy, cauterization, topical chemical and antiviral agents, and/or oral cimetidine are used in refractory cases or to accelerate the healing process. Herein, we discussed the clinical findings and our treatment of two patients with unilateral chronic conjunctivitis associated with eyelid MC lesions in light of the literature.
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Affiliation(s)
- Şule Serin
- Selçuk University Faculty of Medicine, Department of Ophthalmology, Konya, Turkey
| | - Ayşe Bozkurt Oflaz
- Selçuk University Faculty of Medicine, Department of Ophthalmology, Konya, Turkey
| | - Pınar Karabağlı
- Selçuk University Faculty of Medicine, Department of Pathology, Konya, Turkey
| | - Şansal Gedik
- Selçuk University Faculty of Medicine, Department of Ophthalmology, Konya, Turkey
| | - Banu Bozkurt
- Selçuk University Faculty of Medicine, Department of Ophthalmology, Konya, Turkey
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Gaurkar SP, Pund PB, Dindore PR, Bhoi UY. Extensive molluscum contagiosum causing obstruction of vision in HIV positive woman. Indian Dermatol Online J 2016; 7:190-1. [PMID: 27294056 PMCID: PMC4886593 DOI: 10.4103/2229-5178.182360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We report a case of a person living with HIV-AIDS who presented with extensive molluscum contagiosum (MC) in the periorbital location. MC lesions aggregated as large masses over the right upper and lower eyelids, obstructing vision of the right eye.
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Affiliation(s)
- Sudarshan P Gaurkar
- Rajarshee Chatrapati Shahu Maharaj (RCSM) Government Medical College, Kolhapur, Maharashtra, India
| | - Poonam B Pund
- Rajarshee Chatrapati Shahu Maharaj (RCSM) Government Medical College, Kolhapur, Maharashtra, India
| | - Pradeep R Dindore
- Department of Ophthalmology, Dr. DY Patil Medical College, Kolhapur, Maharashtra, India
| | - Umesh Y Bhoi
- Rajarshee Chatrapati Shahu Maharaj (RCSM) Government Medical College, Kolhapur, Maharashtra, India
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Fernando I, Pritchard J, Edwards SK, Grover D. UK national guideline for the management of Genital Molluscum in adults, 2014 Clinical Effectiveness Group, British Association for Sexual Health and HIV. Int J STD AIDS 2014; 26:687-95. [PMID: 25332225 DOI: 10.1177/0956462414554435] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Jill Pritchard
- Sexual Health Ashford and St Peter's Hospital, Chertsey, Surrey, UK
| | - Sarah K Edwards
- Sexual Health Cambridgeshire Community Services, Cambridgeshire, UK
| | - Deepa Grover
- Barnet General Hospital, Hertfordshire, UK Royal Free Hospital, London, UK
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8
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Chern KC, Meisler DM. Less Common Viral Corneal Infections. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00088-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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9
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Hood CT, Jeng BH, Lowder CY, Holland GN, Meisler DM. Corneal and External Ocular Infections in Acquired Immunodeficiency Syndrome (AIDS). Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00074-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Jeng BH, Holland GN, Lowder CY, Deegan WF, Raizman MB, Meisler DM. Anterior Segment and External Ocular Disorders Associated with Human Immunodeficiency Virus Disease. Surv Ophthalmol 2007; 52:329-68. [PMID: 17574062 DOI: 10.1016/j.survophthal.2007.04.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The eye is a common site for complications of human immunodeficiency virus (HIV) infection. Although cytomegalovirus retinitis remains the most prevalent of the blinding ocular disorders that can occur in individuals with the acquired immunodeficiency syndrome (AIDS), several important HIV-associated disorders may involve the anterior segment, ocular surface, and adnexae. Some of these entities, such as Kaposi sarcoma, were well described, but uncommon, before the HIV epidemic. Others, like microsporidial keratoconjunctivitis, have presentations that differ between affected individuals with HIV disease and those from the general population who are immunocompetent. The treatment of many of these diseases is challenging because of host immunodeficiency. Survival after the diagnosis of AIDS has increased among individuals with HIV disease because of more effective antiretroviral therapies and improved prophylaxis against, and treatment of, opportunistic infections. This longer survival may lead to an increased prevalence of anterior segment and external ocular disorders. In addition, the evaluation and management of disorders such as blepharitis and dry eye, which were previously overshadowed by more severe, blinding disorders, may demand increased attention, as the general health of this population improves. Not all individuals infected with HIV receive potent antiretroviral therapy, however, because of socioeconomic or other factors, and others will be intolerant of these drugs or experience drug failure. Ophthalmologists must, therefore, still be aware of the ocular findings that develop in the setting of severe immunosuppression. This article reviews the spectrum of HIV-associated anterior segment and external ocular disorders, with recommendations for their evaluation and management.
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Affiliation(s)
- Bennie H Jeng
- The Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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Affiliation(s)
- Rasha Ali
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Boston, MA 02114, USA
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Schornack MM, Siemsen DW, Bradley EA, Salomao DR, Lee HB. Ocular manifestations of molluscum contagiosum. Clin Exp Optom 2006; 89:390-3. [PMID: 17026608 DOI: 10.1111/j.1444-0938.2006.00073.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Two cases of molluscum contagiosum (MC) are presented to illustrate the range of potential anterior segment complications of this condition. METHODS Clinical records for two patients diagnosed with MC are retrospectively reviewed. Diagnosis and management of both cases are presented. RESULTS The first patient demonstrates a classic presentation of ocular MC. The patient was young and had several dermal lid lesions at the time of presentation. The second case represents a less common presentation. The patient was an adult and had a single lid lesion that was not apparent at the initial examination. Both patients had follicular conjunctivitis that resolved with excision of the concomitant eyelid lesions. CONCLUSION MC is a treatable cause of chronic conjunctivitis or keratoconjunctivitis. Eye-care providers should be mindful that MC could present as a follicular keratoconjunctivitis with or without obvious dermal lid lesions. The possibility of immuno-compromise must be considered in patients with multiple large lesions, cutaneous lesions that do not respond to standard therapy, or recurrent lesions.
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Ng WT, Versace P. Ocular association of HIV infection in the era of highly active antiretroviral therapy and the global perspective. Clin Exp Ophthalmol 2005; 33:317-29. [PMID: 15932540 DOI: 10.1111/j.1442-9071.2005.01001.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ocular involvement is a common complication of HIV infection. Since the late 1990s, widespread use of highly active antiretroviral therapy (HAART) has altered the spectrum, and reduced the incidence of ocular involvement in developed countries. The incidence of the most common ocular opportunistic infection, cytomegalovirus retinitis, has decreased tremendously. However, immune recovery uveitis secondary to HAART has emerged as a frequent visually threatening condition. Early diagnosis and treatment with periocular steroids is helpful in minimizing visual loss. Clinicians should also be aware that certain antimicrobial agents used to treat opportunistic infections in HIV-positive patients are associated with potentially serious ocular side effects. In developing countries, where most of the world's 40 million HIV-positive patients live, the spectrum and incidence of ocular involvement differ from those in developed countries. The lack of HAART availability is among the many causes of these differences, which may include nutritional factors, basic medical care availability and the levels of exposure to different infectious agents. These factors add to the already challenging task of treating ocular complications and preventing blindness in HIV-positive patients in developing countries.
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Affiliation(s)
- Weng T Ng
- Department of Ophthalmology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
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Schulz D, Sarra GM, Koerner UB, Garweg JG. Evolution of HIV-1-related conjunctival molluscum contagiosum under HAART: report of a bilaterally manifesting case and literature review. Graefes Arch Clin Exp Ophthalmol 2004; 242:951-5. [PMID: 15221307 DOI: 10.1007/s00417-004-0925-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2003] [Revised: 02/26/2004] [Accepted: 03/02/2004] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To present a rare case of bilateral conjunctival molluscum contagiosum (MC) in an HIV-positive individual who had unilateral lesion excision before induction of highly active antiretroviral therapy (HAART), and to discuss the pathophysiological consequences of immune restoration. METHODS CASE REPORT A 40-year-old male Caucasian presented with atypical, bilateral lesions of the limbal conjunctiva due to MC. Before the induction of HAART, nodules in the left eye were excised whilst the single lesion in the right eye was left untouched. RESULTS The clinical diagnosis of conjunctival MC was confirmed histopathologically. Six months after the induction of HAART, the untouched lesion (right eye) had regressed and there was pronounced local injection of the conjunctiva. MC lesions did not recur after excision (left eye), and signs of inflammation were absent. CONCLUSION Conjunctival MC is rare and associated with immune deficiency. To the best of our knowledge, the presented case is the first reported instance of bilateral, multi-lesional MC of the conjunctiva in an HIV-positive patient undergoing HAART. Attention must be paid to the possible complications associated with the restoration of immunocompetence.
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Affiliation(s)
- Dominic Schulz
- Department of Ophthalmology, University of Bern, Inselspital, 3010, Bern, Switzerland
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Abstract
Injection drug use can result in a variety of severe ocular conditions. Hematogenous dissemination of various fungi and bacteria may produce endophthalmitis with resultant severe visual loss. Retinal arterial occlusive disease may result from talc and other particulate emboli. Most commonly, life-threatening systemic diseases such as endocarditis and HIV infection secondarily affect the eye. Because many of these conditions may result in blindness if untreated, accurate diagnosis and prompt initiation of therapy are essential.
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Affiliation(s)
- Rubin W Kim
- Kresge Eye Institute, Department of Ophthalmology, Wayne State University School of Medicine, 4717 St. Antoine, Detroit, MI 48201, USA
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Abstract
A variety of ocular disease processes have been identified in HIV-antibody positive persons, especially in people with AIDS. The most common sight-threatening disease in this population is cytomegalovirus (CMV) retinitis. Effective therapies are available to treat CMV retinitis. However, such therapies carry potentially challenging toxicities. Highly active antiretroviral therapy (HAART) has improved immune system functioning in many of its adherents, decreasing the incidence and improving the clinical course of CMV retinitis. However, a recent phenomenon associated with HAART, immune recovery uveitis (IRU), has been noted with additional, often problematic ocular manifestations in many persons with CMV retinitis. Periodic ophthalmic examination is prudent for all persons with HIV and especially for people with AIDS.
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Abstract
Ophthalmic abnormalities are common in HIV-infected patients. Serious ophthalmic diseases often result from opportunistic infections and can cause blindness in the absence of prompt diagnosis and therapy. We review recent advances in the diagnosis and management of HIV-associated ocular disease, including cytomegalovirus retinitis, the leading cause of vision loss in HIV-infected patients. The widespread use of highly active antiretroviral therapy (HAART) over the past 3 years has reduced the morbidity and mortality associated with HIV infection. HAART has dramatically altered the incidence and natural history of many opportunistic infections, and we discuss the impact of HAART on ophthalmic disease.
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Affiliation(s)
- M R Robinson
- National Institutes of Health, National Eye Institute, Bethesda, Maryland 20892-1863, USA.
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Scolaro MJ, Gordon P. Electron-beam therapy for AIDS-related molluscum contagiosum lesions: preliminary experience. Radiology 1999; 210:479-82. [PMID: 10207432 DOI: 10.1148/radiology.210.2.r99fe36479] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the effects of electron-beam therapy on cutaneous molluscum contagiosum lesions in patients with acquired immunodeficiency syndrome (AIDS), because current treatment modalities are limited in their effectiveness and by long-term rates of lesion recurrence. MATERIALS AND METHODS Five patients with AIDS, with 23 molluscum contagiosum lesion sites, received electron-beam radiation treatment of recurrent molluscum contagiosum lesions. RESULTS All 23 lesions treated resolved completely and have not recurred during up to 24 months of follow-up. Radiation therapy was well tolerated; mild skin erythema was the only reported side effect. CONCLUSION The use of electron-beam radiation is a promising alternative to current treatment modalities.
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Affiliation(s)
- M J Scolaro
- A Medical Corporation, Beverly Hills, CA 90211, USA
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Leahey AB, Shane JJ, Listhaus A, Trachtman M. Molluscum contagiosum eyelid lesions as the initial manifestation of acquired immunodeficiency syndrome. Am J Ophthalmol 1997; 124:240-1. [PMID: 9262550 DOI: 10.1016/s0002-9394(14)70791-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To report molluscum contagiosum as the initial manifestation in acquired immunodeficiency syndrome (AIDS). METHOD Case report. A 34-year-old man was examined with atypical, extensive molluscum contagiosum of the eyelids. RESULTS Biopsy of the lesions confirmed molluscum contagiosum, and a previously normal fundus now disclosed bilateral cotton wool spots and classic signs of cytomegalovirus retinitis in the left eye. Human immunodeficiency virus (HIV) antibody testing was positive. CONCLUSIONS Manifestation of atypical and extensive eyelid molluscum contagiosum may warrant additional history taking, comprehensive ophthalmic examination, including dilated ophthalmoscopic examination, and HIV testing.
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Affiliation(s)
- A B Leahey
- Department of Surgery, Lehigh Valley Hospital, Allentown, PA, USA
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Abstract
As a result of improved treatment and patient survival, ophthalmic complications are now being seen with increasing frequency in AIDS, occurring in up to 75% of patients during the course of the disease. The eye may be involved by an AIDS-related microvasculopathy, which gives rise to cotton wool spots, and by opportunistic infections caused by a wide range of organisms, including cytomegalovirus, herpes simplex virus, varicella zoster, Toxoplasma gondii, Mycobacterium avium-intracellulare, Treponema pallidum, Pneumocystis carinii and various fungal agents. Opportunistic infections may be the presenting sign of disseminated infection. The eye may also be involved by neoplasms such as Kaposi's sarcoma and lymphoma, and by intracranial disease. Ocular involvement may lead to blindness if untreated and prompt ophthalmological referral is essential. This article reviews the range of ocular diseases seen in HIV and AIDS, current therapeutic options and outcome.
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Affiliation(s)
- F G Ah-Fat
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
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Nakanishi AK, Soltau JB. Common viral infections of the eye. Pediatr Ann 1996; 25:542-4, 546-7, 550 passim. [PMID: 8902865 DOI: 10.3928/0090-4481-19961001-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- A K Nakanishi
- Department of Pediatrics, St Louis University School of Medicine, MO 63104, USA
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Abstract
The incidence of certain microbial infections occurring in the oropharynx is well documented, but infection by other pathogens, although highly probable, has not been established with certainty. Considerable recent interest in the incubation period of various infections and improved community surveillance programs combine to ascribe infection to specific incidents. It is prudent for health care personnel to acknowledge the presence of many sexually transmitted diseases in the oropharynx and consider them in the differential diagnosis of many well-established conditions.
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Affiliation(s)
- G T Terezhalmy
- Department of Dentistry, Cleveland Clinic Foundation, Ohio, USA
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Bardenstein DS, Elmets C. Hyperfocal cryotherapy of multiple Molluscum contagiosum lesions in patients with the acquired immune deficiency syndrome. Ophthalmology 1995; 102:1031-4. [PMID: 9121748 DOI: 10.1016/s0161-6420(95)30916-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Patients with the acquired immune deficiency syndrome are at risk for the development of multiple lesions of Molluscum contagiosum on the eyelids. In this setting, traditional methods of treatment frequently are ineffective and pose risks to the patient as well as to the treating physician. METHODS A technique was developed that combined lidocaine/prilocaine topical anesthesia with hyperfocal cryotherapy. Twelve patients with multiple M. contagiosum lesions of the eyelids were treated. Initially, two methods were used: one application for 30 seconds or two applications for 20 seconds. RESULTS Lesions treated with two 20-second applications regressed. Most of those lesions treated for 30 seconds regressed. No scarring, lash complications, ptosis, or damage to the underlying cornea or deeper ocular structures was observed in any patient. CONCLUSIONS Hyperfocal cryotherapy is an effective therapy for multiple M. contagiosum lesions of the periorbital region, posing minimal risk to the patient and physician. It is particularly useful in patients who are positive for the human immunodeficiency virus, who frequently have multiple lesions, are likely to have recurrent disease, and who pose risks of disease transmission to the medical personnel caring for them.
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Affiliation(s)
- D S Bardenstein
- Department of Ophthalmology, Case-Western Reserve University School of Medicine, Cleveland, OH, USA
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Affiliation(s)
- L Akduman
- Washington University, Department of Ophthalmology and Visual Sciences, St Louis, MO 63110-1093, USA
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Charteris DG, Bonshek RE, Tullo AB. Ophthalmic molluscum contagiosum: clinical and immunopathological features. Br J Ophthalmol 1995; 79:476-81. [PMID: 7612562 PMCID: PMC505139 DOI: 10.1136/bjo.79.5.476] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AIMS A study of ophthalmic molluscum contagiosum infection was undertaken to define its clinical presentation and immunopathological features. METHODS Retrospective analysis of 35 cases of histologically proved molluscum contagiosum infection was carried out. Diagnosis was delayed in 40% of cases resulting in repeated clinic visits. RESULTS Twenty one patients were noted to have ocular surface changes; two patients were immunocompromised. All cases were eventually treated by excision of the lesion (19 had cautery to the lesion base) and there was recurrence in two cases. Immunohistochemical analysis of biopsy specimens showed that T lymphocytes were a consistent finding in adjacent dermis and epidermis although they did not infiltrate the molluscum lesions. Smaller numbers of macrophages were also demonstrated. There was a notable cross reactivity by a T cell antibody to the molluscum bodies. CONCLUSION The study shows the varied presentation of molluscum contagiosum infection to the ophthalmologist and the nature of the local immune response to the virus.
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Merisier H, Cochereau I, Hoang-Xuan T, Toublanc M, Ruggeri C. Multiple molluscum contagiosum lesions of the limbus in a patient with HIV infection. Br J Ophthalmol 1995; 79:393-4. [PMID: 7742295 PMCID: PMC505113 DOI: 10.1136/bjo.79.4.393] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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McFadden G, Kane K. How DNA viruses perturb functional MHC expression to alter immune recognition. Adv Cancer Res 1994; 63:117-209. [PMID: 8036987 DOI: 10.1016/s0065-230x(08)60400-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- G McFadden
- Department of Biochemistry, University of Alberta, Edmonton, Canada
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