Interferon-alpha treatment of molluscum contagiosum in a patient with hyperimmunoglobulin E syndrome

British Association for Sexual Health and HIV national guideline for the management of Genital Molluscum in adults (2021)

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.

Molluscum contagiosum: an update and review of new perspectives in etiology, diagnosis, and treatment

Molluscum contagiosum (MC) is a self-limited infectious dermatosis, frequent in pediatric population, sexually active adults, and immunocompromised individuals. It is caused by molluscum contagiosum virus (MCV) which is a virus of the Poxviridae family. MCV is transmitted mainly by direct contact with infected skin, which can be sexual, non-sexual, or autoinoculation. Clinically, MC presents as firm rounded papules, pink or skin-colored, with a shiny and umbilicated surface. The duration of the lesions is variable, but in most cases, they are self-limited in a period of 6–9 months. The skin lesions may vary in size, shape, and location, which is more frequent in immunosuppressed patients, and could present complications such as eczema and bacterial superinfection. The diagnosis is based on clinical findings. A useful clinical tool is dermoscopy. If the diagnostic doubt persists, confocal microscopy or skin biopsy could be performed. The need for active treatment for MC is controversial; however, there is a consensus that it should be indicated in cases of extensive disease, associated with complications or aesthetic complaints. There are several treatment modalities which include mechanical, chemical, immunomodulatory, and antivirals. The objective of this article is to review the current evidence in etiology, clinical manifestations, diagnosis, and management alternatives of MC.

Generalized Molluscum Contagiosum Successfully Treated with Interferon-Alpha in a Patient with Folliculotropic Mycosis Fungoides

We present the case of a 50-year-old patient with folliculotropic mycosis fungoides (FMF) unresponsive to retinoids and the chemotherapeutic regimens CHOP, gemcitabine, and brentuximab-vedotin. During immunosuppressive therapy, the patient developed extensive progressive molluscum contagiosum. The mollusca did not respond to topical imiquimod but showed a swift complete response to interferon-alpha 2a (IFNa). Recently, the patient started with alemtuzumab as induction therapy for an allogenic stem cell transplantation and simultaneously continued IFNa therapy.

Molluscum Contagiosum: Review and Update on Management

Molluscum contagiosum (MC) is an infectious dermatosis that commonly presents in children and immunocompromised individuals. Although lesions usually resolve spontaneously after several months, they can be symptomatic and cause psychosocial distress. We review the evidence underlying treatment methods available for MC lesions, including potassium hydroxide, salicylic acid, hydrogen peroxide, retinoids, cantharidin, cryotherapy, curettage, and pulsed dye laser to aid practicing dermatologists in therapy selection.

Treatment of molluscum contagiosum in adult, pediatric, and immunodeficient populations

BACKGROUND

Molluscum contagiosum is a viral infection of the skin that is widely considered to be a self-resolving disease that can be treated with benign neglect. However, the clinical reality is that the disease can vary widely by anatomic site and by recalcitrance to treatment and remains a significant cause of morbidity worldwide.

OBJECTIVE

The purpose of this review was to compile an updated resource for clinicians that addresses the management of the broad spectrum of molluscum cases that may be encountered.

METHODS

A comprehensive PubMed search was performed to identify publications on the treatment of molluscum infection, including presentations that may be rare or difficult.

RESULTS

The specific clinical scenario of molluscum must be considered when selecting the optimal therapy because certain treatments can be more effective for specific patient subpopulations.

CONCLUSION

Further attention must be directed toward standardizing treatment for molluscum infection based on patient age and immune status.

Recurrent and Sustained Viral Infections in Primary Immunodeficiencies

Viral infections are commonplace and often innocuous. Nevertheless, within the population of patients with primary immunodeficiencies (PIDDs), viral infections can be the feature that drives a diagnostic evaluation or can be the most significant morbidity for the patient. This review is focused on the viral complications of PIDDs. It will focus on respiratory viruses, the most common type of viral infection in the general population. Children and adults with an increased frequency or severity of respiratory viral infections are often referred for an immunologic evaluation. The classic teaching is to investigate humoral function in people with recurrent sinopulmonary infections, but this is often interpreted to mean recurrent bacterial infections. Recurrent or very severe viral infections may also be a harbinger of a primary immunodeficiency as well. This review will also cover persistent cutaneous viral infections, systemic infections, central nervous system infections, and gastrointestinal infections. In each case, the specific viral infections may drive a diagnostic evaluation that is specific for that type of virus. This review also discusses the management of these infections, which can become problematic in patients with PIDDs.

Cytokine immunomodulation for the treatment of infectious diseases: lessons from primary immunodeficiencies

Traditionally, management of infectious diseases focuses on identification of the causative microbe and the use of pathogen-targeted therapy. With increasing antimicrobial resistance, novel approaches are required. One strategy is to modulate those natural host immune responses that critically mediate resistance to specific microbes. Clinically, this host-directed tactic could be used either alone or in combination with antimicrobial therapy. While conceptually attractive, there is potential concern that the pathways governing host resistance to pathogens in animal models may not extrapolate linearly to humans. Targeting these immune processes clinically may precipitate damaging, epiphenomenal responses. The field of Primary Immunodeficiencies focuses on the characterization of humans with inborn errors of immunity. These rare conditions permit the identification of those molecular and cellular processes that are central to human susceptibility to microbes. In efforts to compensate for defective host responses, this field has also provided a wealth of clinical experience in the effective use of cytokines to treat various active infections, while demonstrating their safety. In this review, we provide a historical perspective of the treatment of infectious diseases, evolving from a focus on the microbe, to an understanding of human immunity; we then outline the growing contribution of Primary Immunodeficiencies to the rational use of adjunctive cytokine immunotherapy in the management of infections.

Do you know this syndrome?

The hyperimmunoglobulin E syndrome, or Job's syndrome is a rare primary immunodeficiency characterized by recurrent skin abscesses, recurrent respiratory tract infections, and high levels of IgE, eosinophilia, bone and dental changes. We report the case of a fourteen-year-old male patient presenting this disease, with both typical and also some relatively sporadic manifestations. We performed a literature review on the syndrome and its associated clinical findings.

Clinical, immunological and genetic features in Taiwanese patients with the phenotype of hyper-immunoglobulin E recurrent infection syndromes (HIES)

Hyper-immunoglobulin E recurrent infection syndromes (HIES) have distinct features, with identified associated mutations of STAT3, TYK2, and DOCK8. Among 197 Taiwanese patients with primary immunodeficiency on a referral-base of over 23 million inhabitants, STAT3 (R382W and Q469R) and DOCK8 mutations (exon 1-9 deletion) were identified in two patients each from six AD-HIES and five AR-HIES patients, respectively. Aside from decreased Th17 and memory B cells, characteristic facies and pneumatocele were not mutually exclusive regardless of STAT3 and DOCK8 mutations. One with novel DOCK8 deletion had notable cytomegalovirus retinitis, cerebral vasculitis, lead deposition, and amenorrhea. In adolescence, three AD-HIES patients without STAT3 mutation died of myocardial infarction, staphylococcus sepsis, and proteus sepsis while receiving chemotherapy for lymphoma. Close follow-up of the HIES phenotype rather than identifying genetic mutations should be the cornerstone of intervention at this juncture because of relatively lower percentage of identifying mutations in Taiwanese HIES (4/11; 36.5%).

Clinical aspects and genetic analysis of Taiwanese patients with the phenotype of hyper-immunoglobulin E recurrent infection syndromes (HIES)

BACKGROUND

Hyper-immunoglobulin E recurrent infection syndromes (HIES) has characteristic features and identified mutations. This study investigated clinical features and causal candidate mutations in Taiwanese patients with the HIES phenotype on referral base over 23 million inhabitants.

PATIENTS AND METHODS

Clinical manifestations of the HIES phenotype, severity scoring, immunological functions and candidate genes of signal transducer and activator of transcription 3 (STAT3), tyrosine kinase 2 (TYKZ), and dedicator of cytokineses 8 (DOCK8) were analyzed.

RESULTS

Between 1985 and 2009, six sporadic and two siblings met HIES criteria (onset age: 2-54 months; severity score: 31-65) out of 187 patients with primary immunodeficiencies. Five patients with the autosomal dominant (AD)-HIES phenotype presented as pneumatocoele, bronchiectasis, retained primary teeth, minor trauma fracture, scoliosis, coronary aneurysm, and lymphoma. Three with the autosomal recessive (AR)-HIES phenotype and impaired lymphocyte proliferation function had herpes simplex virus infection, molluscum contagiosum, and cerebral vasculitis. Notably in one patient with the AR-HIES phenotype, unintentional lead component in traditional application herbs for accelerating wound healing deposited in basal ganglia and aggravated involuntary movement relative to cerebral vacculitis. Those with mildly elevated memory T cells and decreased memory B cells trended to develop arteritis. Of five AD-HIES patients, three were mortalities from acute myocardial infarction, Proteus mirabilis, and Staphylococcus aureus sepsis. Only one had de novo novel STAT3 (Gln 469 Arg) mutation with "relative" lower HIES STAT3 score.

CONCLUSIONS

Known genetic defects responsible for the HIES phenotype are not so common in Taiwan. This may infer genetic variations in different ethnicities although selection bias and under-diagnosis for HIES with known genetic defects could be contribution factors.

Disseminated giant molluscum contagiosum in a patient with idiopathic CD4+ lymphocytopenia. Successful eradication with systemic interferon

Idiopathic CD4+ lymphocytopenia is a rare disease without HIV infection or any other underlying immunodeficiency. Patients with this condition are predisposed to various opportunistic infections. We describe a 31-year-old woman with giant molluscum contagiosum disseminated over nearly the whole body. Immunologic analysis disclosed very low numbers of CD4+ lymphocytes (<11/microl, normal range: 240-3,100), an abnormal proliferative response of the patient's lymphocytes to artificial mitogens and specific antigens, and an anergic delayed-type hypersensitivity skin response. HIV serology was repetitively negative. The diagnosis of idiopathic CD4+ lymphocytopenia was established. Systemic treatment with pegylated interferon-alpha2b (50 microg/week) for 16 months resulted in complete eradication of her disseminated giant molluscum contagiosum. In this report we will further describe the nature of idiopathic CD4+ lymphocytopenia and emphasize its relevance to clinical dermatology.