(BMJ)—A 6-year-old boy with HIV presented with a 5-month hx of enlarging lesions on his face. His family reported that he’d intermittently discontinued his antiretrovirals. Exam: multiple painless, firm, dome-shaped nodules with central umbilication. What’s the dx?
Verruca vulgaris
Molluscum contagiosum
Coccidioidomycosis
Kaposi sarcoma
Keratoacanthoma
You are correct. The clinical dx of molluscum contagiosum was made based on the characteristic central umbilication. In immunocompromised patients, the lesions can become disseminated, large, and resistant to tx. Although curettage, cryotherapy, and topical treatments are among the available tx options, immunocompetent patients don’t require tx because the lesions are self-limiting and benign.

Mollusca that are large, fast growing, and refractory to tx should prompt investigation for underlying immunosuppression. If patients are already receiving tx, this presentation should prompt discussion about tx adherence.

BMJ 2022;378:e069221