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July 2008
By Kelly K. Park, BS, Youn W. Park, MD, FACS, Kirkland Lau, DO, and Stephen M. Schleicher, MD
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CASE:
A 58-year-old man with a history of chronic obstructive pulmonary disease presents to your emergency department with more than 100 asymptomatic, umbilicated papules ranging in diameter from 2 to 7 mm. The patient first noticed the lesions on his lower abdomen six months ago; they then spread rapidly to other parts of his body. Recently, he began having night sweats and losing weight. Physical examination also reveals palpable inguinal lymph nodes.
WHAT IS YOUR DIAGNOSIS? |
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This patient has widespread molluscum contagiosum. The condition is caused by a poxvirus and transmitted by direct skin contact. It most commonly infects children, sexually active adults, and immunosuppressed individuals, causing umbilicat-ed, dome-shaped papules between 1 and 5 mm in diameter. After further diagnostic testing, this patient was found to be HIV-positive. Almost all patients infected with HIV and molluscum contagiosum will have a helper T-cell count below 100 and will be diagnosed with AIDS.
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Ms. Park is a medical student and Dr. Park is a clinical professor of otolaryngology at Northeastern Ohio Universities College of Medicine in Rootstown, Ohio. He is also section head of otolaryngology at Barberton Hospital in Barberton, Ohio. Dr. Lau is an associate with a division of DermDx Centers for Dermatology in Sinking Spring, Pennsylvania. Dr. Schleicher is director of DermDx Centers and a clinical instructor of dermatology at the Philadelphia College of Osteopathic Medicine, at Kings College in Wilkes-Barre, Pennsylvania, and at Arcadia University in Glenside, Pennsylvania. He is also a member of the EMERGENCY MEDICINE editorial board.
Emerg Med 40(7):27-28, 2008
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