Molluscum contagiosum in a patient with adult T-cell
A 55-year-old Taiwanese female presented with the insidious
onset of intermittent fever, anorexia and weight loss over a 2-
month period. In addition, multiple non-pruritic papules with
hyperkeratosis and scaling had developed on her face, scalp,
trunk and limbs during the 2 weeks prior to admission (left).
On examination, palpable splenomegaly was noted. A full
blood count showed a white blood cell count of 48Æ3 · 109/l
with a differential count of neutrophils 48%, lymphocytes
39%, monocytes 7%, and band forms 2%. Peripheral blood
films showed no flower-like cells. However, a positive family
history of adult T-cell leukaemia/lymphoma (ATLL) in two of
her siblings led to detection of positive serology for human T-
lymphotropic virus type I (HTLV-I). A bone marrow exam-
ination showed hypercellularity and prominently increased
small lymphocytes with indentated or cleft nuclei, which
expressed CD3, CD4, CD5 and CD25 and were negative for
CD7, compatible with ATLL. Excisional biopsy of a skin lesion
under the impression of leukaemia cutis unexpectedly showed
characteristic molluscum bodies in the epidermis of affected
skin, pathognomonic of molluscum contagiosum. (right,
arrow indicates viral particles).
Specific cutaneous lesions of ATLL in which leukaemic
infiltrates are seen include papules, plaques, nodules, tumours,
nonspecific erythematous patches and erythroderma. Less
commonly reported is opportunistic skin infestation with
scabies. Adedayo et al (2003) reported an HTLV-I carrier who
presented with disseminated molluscum contagiosum and
pulmonary cryptococcosis. Together with our report, this
suggests that the molluscum contagiosum virus may be an
opportunistic infectious pathogen when there is severely
compromised T-lymphocyte function.
1Division of Haematology and Oncology, Department of Medicine,
2National Yang-Ming University School of Medicine,3Division of
Haematology and Oncology, Department of Medicine, Yangming branch
of Taipei City Hospital,4Department of Pathology and Laboratory
Medicine, Taipei Veterans General Hospital, and5Division of
Transfusion Medicine, Department of Medicine, Taipei, Taiwan.
E-mail: email@example.com; firstname.lastname@example.org
Adedayo, A.O., Bascom, C., Grell, G.C., Bellot, P., Adebiyi, R. & Chandra, P.
(2003) Disseminated molluscum contagiosum and pulmonary cryptococcosis
coexisting in an HTLV-1 seropositive patient. Journal of the European Acad-
emy of Dermatology and Venereology, 17, 723–724.
images in haematology
First published online 16 June 2011
ª 2011 Blackwell Publishing Ltd, British Journal of Haematology, 155, 286