You are correct. Molluscum lesions are small, benign, pearly papules caused by a poxvirus. Molluscum is most common on the face and trunk in children and in the genital area in sexually active adults. Molluscum is uncommon on the face of healthy adults and should prompt investigation for immunocompromise, including CBC and HIV serology. This patient was found to be HIV positive and was treated with HAART and topical imiquimod. Molluscum infection is usually self-limited, and treatment is not required in otherwise healthy patients.

You are correct. Swabs from the lesions tested positive for HSV1 by PCR. Occasionally, as in this case, autoinoculation can cause lesions at multiple sites. HSV1 is usually uncomplicated in immunocompetent hosts. Lesions last 10 to 14 days. Oral antiviral treatment shortens the duration and reduces symptoms.

You are correct. MRI showed carotid artery dissection, without abnormal signal in the hypoglossal nerve. Isolated hypoglossal nerve palsy is associated with lesions of the peripheral segment rather than at the brainstem origin. The hypoglossal nerve passes between the carotid artery and the internal jugular vein. In one series, >5% of patients with internal carotid artery dissection presented with isolated hypoglossal nerve involvement. This patient was treated with antihypertensive and antiplatelet medication. Symptoms improved by 3 weeks after admission.

You are correct. Reexpansion pulmonary edema is a complication of drainage of pleural effusions and pneumothoraces. Large volume, clear (not bloody) sputum is common. X-ray reveals unilateral diffuse airspace opacification of the reinflated lung with the chest tube in place. Management is supportive. The use of diuretics for the condition is controversial. This patient rapidly improved with high-flow O2, morphine, and furosemide; he was discharged 2 days later.

You are correct. Blistering distal dactylitis is a superficial bacterial infection of the anterior fat pad, typically caused by gram-positive organisms. It presents with large blisters or bullae affecting multiple fingers. His clinicians hypothesized that lacing up hockey skates may have caused superficial microtrauma to the hands, predisposing to potential infection. Moist, infrequently washed hockey equipment may have harbored infectious organisms. He improved after 10 days of oral cephalexin, blister debridement via lateral puncture, and silver sulfadiazine dressings.

You are correct. Nasal polyps, a benign inflammation of the nasal sinus mucosa, are a common cause of nasal obstruction and often result from chronic rhinosinusitis. Initial treatment is with topical steroids. This patient did not respond to steroids; nasal polypectomy was performed.