MOLLUSCUM CONTAGIOSUM, INVOLVING THE UPPER EYELIDS, IN A CHILD INFECTED WITH HIV-1

Background. Infection with molluscum contagiosum has been reported in pediatric and adult patients with acquired immune deficiency syndrome (AIDS), but rarely affecting eyelids. We have studied the viral phenot ype, HIV-1 plasma viremia, p24 antigenemia, alterations of cellular im mune function, and the ophthalmological status in a 5-year old human i mmunodeficiency virus type 1 infected girl, who developed multiple mol luscum lesions, bilaterally involving upper eyelids with extension ove r the face and nose. Methods. Detailed ophthalmological examination an d immunological and virological studies were performed in a pediatric patient with HIV-1 vertical infection having extensive infection with molluscum contagiosum. Results. The pediatric patient was emetropic; t ricomegalia was present bilaterally, and alteration of the microvessel s of the conjunctiva (microangiopathy) was observable in both eyes and structural (fibrilar) degeneration of the vitreous architecture in bo th eyes. There was no ophthalmoscopic sign of infectious retinitis or retinal microangiopathy. She had lymphopenia, very low percentage and absolute number of CD4(+) T cells but increased percentage of CD8(+) T cells. The in vitro lymphocyte proliferative response to phytohemaglu ttinin (PHA) was depressed as compared to healthy controls. She had hi gh levels of viral HIV RNA in her plasma and of p24 antigen in her ser um, and the phenotype of the isolated HIV-1 was determined to be syncy tium-inducing (SI). Conclusion. Although healthy persons may develop m olluscum contagiosum, usually unilateral, as far as we are aware this report is the first to document a case of molluscum contagiosum with b ilateral eyelid involvement in an HIV-1-infected pediatric patient. Ou r observations suggest that this type of infection may be present in H IV-infected children, associated with high viral load and possibly an SI viral phenotype, severe immunoregulatory abnormalities, and poor cl inical status.