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BRIEF COMMUNICATION
Year : 2021  |  Volume : 9  |  Issue : 3  |  Page : 130-132

Inflamed pedunculated giant molluscum contagiosum of eyelid in an immunocompetent child


Department of Ophthalmology, Yenepoya Medical College, Mangalore, Karnataka, India

Date of Submission21-Mar-2020
Date of Decision08-Jun-2021
Date of Acceptance16-Jun-2021
Date of Web Publication27-Sep-2021

Correspondence Address:
Divyalakshmi Kaiyoor Surya
Department of Ophthalmology, Yenepoya Medical College, Mangalore - 575 018, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcor.jcor_24_20

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  Abstract 


Molluscum contagiosum (MC) is a skin infection caused by a member of the Poxvirus family. It typically affects young or immunocompromised individuals.[1]. Lesions are localised localized on the face, arms, legs, and anogenital region. Typically, it presents as single or multiple umbilicated papules or nodules on the skin and eyelid margin and conjunctiva.[2] There are very few reports of giant molluscum presenting as an inflammatory lesion in an immunocompetent patient. Here, we are presenting a case of solitary giant MCmolluscum contagiosum presenting like an inflamed pedunculated mass of eyelid in an immunocompetent child.
A one 1½and half -year- old immunocompetent child presented with an inflamed large umbilicated lesion in upper eyelid which was excised in toto. Excision revealed a gyriform lesion and histopathologic confirmation was done.

Keywords: Giant molluscum, immunocompetent, molluscum contagiosum


How to cite this article:
Surya DK, Arunachalam C. Inflamed pedunculated giant molluscum contagiosum of eyelid in an immunocompetent child. J Clin Ophthalmol Res 2021;9:130-2

How to cite this URL:
Surya DK, Arunachalam C. Inflamed pedunculated giant molluscum contagiosum of eyelid in an immunocompetent child. J Clin Ophthalmol Res [serial online] 2021 [cited 2021 Nov 30];9:130-2. Available from: https://www.jcor.in/text.asp?2021/9/3/130/326792



Molluscum contagiosum (MC) is a skin infection caused by a member of the Poxvirus family. It typically affects young or immunocompromised individuals.[1] Lesions are localized on the face, arms, legs, and anogenital region. Typically, it presents as single or multiple umbilicated papules or nodules on the skin and eyelid margin and conjunctiva.[2] There are very few reports of giant molluscum presenting as an inflammatory lesion in an immunocompetent patient. Here, we are presenting a case of solitary giant MC presenting like an inflamed pedunculated mass of eyelid in an immunocompetent child.


  Case Report Top


A 1 ½-year-old child presented with mass of left eye upper lid of 3-month duration with a history of similar swellings on the face. Lid swelling showed a progressive growth in size with recurrent respiratory infections. A history of similar lesions in the siblings was also noted.

On examination, 10 mm × 10 mm, soft pedunculated lesion with umbilicated pouting surface was noted on the medial one-third of the left upper lid, involving the anterior lid margin sparing the lash margin, lacrimal punctum, and canaliculus. Crusting and scarring of the apex with excoriation of the surrounding skin were seen. The skin over the swelling was mobile except near the umbilicated surface. Increased vascularity was seen with no evidence of bleeding or abnormal discharge [Figure 1]. Mechanical ptosis was noted. Rest of the ocular examination was within normal limits.
Figure 1: Solitary pedunculated giant molluscum of left eye upper lid

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Laboratory investigations revealed hemoglobin of 14.5 gm%, total count of 11600/mm3, with lymphocyte count of 32%, platelets 2.2 lakhs/mm3, serum creatinine 0.7 mg/dl; liver function test was in normal range. Peripheral smear did not show any evidence of atypical cells. Random blood sugar was 67 mg%. Serological investigations including hepatitis B and human immunodeficiency virus were negative. Thus common causes of immunodeficiency were ruled out.

Incision was made along the lid crease. Blunt dissection of the subcutaneous tissue was done. A well-encapsulated gyriform-shaped lesion was excised in toto [Figure 2] and [Figure 3] and tissue sent for histopathology. Primary closure of skin was done. H and E staining of the specimen showed acanthotic epidermis lined by stratified squamous epithelium, invaginated into lobules with homogenous eosinophilic cytoplasmic inclusion bodies [Figure 4], confirming the diagnosis of MC. No recurrence of lesion was noted even at 3-month follow-up.
Figure 2: Complete excision

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Figure 3: Complete excision followed by primary closure

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Figure 4: HPE showing eosinophilic cytoplasmic inclusion bodies

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  Discussion Top


MC is an innocuous condition which spreads by fomites or casual contact or by sexual route.[2] Typically, it presents as an umbilicated papule or a nodule on the face. Atypical lesions with dimensions of 1 cm2 or more are referred to as giant molluscum, seen usually in immunocompromised individuals.[2] There are only a few case reports of giant molluscum involving the eyelids in immunocompetent individuals.[3],[4] It mimics a wide variety of other conditions such as sebaceous cyst, squamous papilloma, pyogenic granuloma, keratoacanthoma. Ornek et al. have reported a 5-year-old immunocompetent child with giant molluscum presenting as a preseptal cellulitis[5] unlike our child who had an inflamed swelling with no evidence of preseptal cellulitis. Complete excision with histopathological examination will confirm the diagnosis.


  Conclusion Top


Solitary giant MC can present like an inflamed pedunculated lesion even in immunocompetent children. Differential diagnosis includes pyogenic granuloma, keratoacanthoma, squamous papilloma. Confirmation can be done by demonstration of eosinophilic inclusion bodies on histopathological examination. Complete excision should be done to prevent recurrences.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lowy DR. Fitzpatrick's Dermatology in General Medicine. Molluscum Contagiosum. 6th ed. New York: McGraw-Hill; 2003. p. 114-7.  Back to cited text no. 1
    
2.
Vardhan P, Goel S, Goyal G, Kumar N. Solitary giant molluscum contagiosum presenting as lid tumor in an immunocompetent child. Indian J Ophthalmol 2010;58:236-8.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Pandhi D, Singhal A. Giant molluscum contagiosum. Indian Pediatr 2005;42:488-9.  Back to cited text no. 3
    
4.
Kumar P, Chatura KR, Kumar VJ, Haravi RM, Chandrasekhar HR. Giant molluscum contagiosum in an infant. Indian J Dermatol Venereol Leprol 1999;65:290-1.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Örnek K, Onaran Z, Koçak M. Giant eyelid molluscum contagiosum presenting as preseptal cellulitis. J Paediatr Child Health 2014;50:1036.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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