Ocular Molluscum Contagiosum Atypical Clinical Presentation

Article (PDF Available)inThe Pediatric Infectious Disease Journal 33(6):668 · June 2014with45 Reads
DOI: 10.1097/INF.0000000000000258 · Source: PubMed

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668 | www.pidj.com The Pediatric Infectious Disease Journal  •  Volume 33, Number 6, June 2014
To the Editors:
Molluscum contagiosum (MC), a com-
mon childhood condition, is a cuta-
neous viral infection caused by poxvirus
that replicates in the cytoplasm of epider-
mal cells.1 It typically produces benign,
self-limiting eruptions on skin and mucous
membranes. MC lesions are commonly seen
on the face, trunks, limbs and genital areas (in
sexually active young adults; for more infor-
mation on molluscum contagiosum, visit the
Centers for Disease Control and Prevention
website at http://www.cdc.gov/ncidod/dvrd/
molluscum/). MC is 1 of the easily over-
looked causes of chronic unilateral conjuncti-
vitis refractory to routine treatment,2 and eye-
lid lesions may assume atypical appearances
or may be initially inconspicuous, thereby
delaying diagnosis and subsequent treatment.
We hereby present 1 such case in a child with
several months of chronic conjunctivitis.
On October 25, 2012, a 13-year-old
female with a 4-month history of chronic
conjunctivitis was referred to an ophthal-
mologist. Her symptoms began in July with
a red, itchy left eye. At that time, she was
evaluated by her pediatrician and received a
presumptive diagnosis of viral conjunctivitis.
When her symptoms failed to resolve, she
was referred to an ophthalmologist who felt
the condition was consistent with bacterial
conjunctivitis and prescribed an antibiotic
ointment. When symptoms again did not
improve, a second opinion was sought result-
ing in a presumptive diagnosis of allergic
conjunctivitis. At this visit, patanol eye drops
were prescribed. Again, symptoms persisted
and in September, the patient additionally
developed a left upper lid lesion, precipitat-
ing a visit to a third ophthalmologist, who
diagnosed her with a chalazion and suggested
warm compresses. The symptoms failed to
resolve and on October 25, 2012, the patient
presented to a 4th ophthalmologist. Here, a
slit lamp examination revealed follicular con-
junctivitis with punctate epithelial erosions
on her cornea. Her left upper lid also showed
a small umbilcated lesion on the central lid
margin. She was diagnosed with a chronic
follicular conjunctivitis of the left eye caused
by molluscum contagiosum. Excision of the
lesion was recommended, and the procedure
was performed on November 14, 2012. The
patient followed up 10 days after the proce-
dure with complete resolution of symptoms.
Two months after the procedure, the patient
continued to be symptom free. The excised
lesion was sent to Centers for Disease Con-
trol and Prevention’s Poxvirus branch.
Extracted DNA was found to be positive for
MC DNA using a real-time quantitative PCR
(qPCR) targeting the MC virus DNA poly-
merase gene locus (see Supplemental Digital
Content 1, http://links.lww.com/INF/B798,
which describes assay).
As seen in this case report, chronic
unilateral conjunctivitis can be an early indi-
cation of a nascent eyelid lesion; however,
children can also present with other ocular
manifestations, ranging from lid abscess to
granuloma3–8 (see Table, Supplemental Digi-
tal Content 2, http://links.lww.com/INF/B799,
which summarizes available case reports and
series on ocular MC). A retrospective analysis
of 35 MC patients visiting a Manchester eye
clinic found that delayed diagnosis of ocular
MC was significantly higher among patients
presenting with conjunctivitis than in those
presenting with non-conjunctivitis symp-
toms. Thus, in patients with persistent uni-
lateral chronic follicular conjunctivitis, MC
should be ruled out by careful examination of
the eyelid margin. Removal of eyelid lesions,
commonly by excision, is the preferred treat-
ment option as it prevents recurrence and
scaring. Although MC is a benign infection,
delay in diagnosis might facilitate spread of
infection and cause discomfort.
Lynda U. Osadebe,
Epidemic Intelligence Service
Scientific Education and Professional
Development Program Office
Division of High Consequence Pathogens
and Pathology (DHCPP)
Poxvirus and Rabies Branch
Centers for Disease Control and Prevention
Atlanta, GA
Yu Li, PhD
Inger K. Damon, MD, PhD
Mary G. Reynolds, PhD
Division of High Consequence Pathogens
and Pathology (DHCPP)
Poxvirus and Rabies Branch
Centers for Disease Control and
Atlanta, GA
Anthony Muyombwe, PhD
Michigan Department of Community
Health/Bureau of Laboratories
Christopher Gappy, MD
Pediatric Ophthalmology and
Adult Strabismus
Kellogg Eye Center
University of Michigan
Ann Arbor, MI
1. Gottlieb SL, Myskowski PL. Molluscum conta-
giosum. Int J Dermatol. 1994;33:453–461.
2. Curtin BJ, Theodore FH. Ocular molluscum con-
tagiosum. Am J Ophthalmol. 1955;39:302–307.
3. Khaskhely NM, Maruno M, Hoshiyama Y,
et al. Molluscum contagiosum appearing as
a solitary lesion on the eyelid. J Dermatol.
4. Ingraham HJ, Schoenleber DB. Epibulbar
molluscum contagiosum. Am J Ophthalmol.
5. van der Meer Maastricht BC, Gomperts CE.
Molluscum contagiosum giganteum. Am J
Ophthalmol. 1950;33:965–967.
6. Shubhangi N. Ocular molluscum contagiosum-A
case Report. Pravara Med Rev 2009;4:3.
7. Rao VA, Baskaran RK, Krishnan MM. Unusual
cases of Molluscum contagiosum of eye. Indian
J Ophthalmol. 1985;33:263–265.
8. Balakrishnan E. Molluscum contagiosum
conjunctivitis. J All India Ophthalmol Soc.
Staphylococcus aureus
Empyema Necessitatis in 
a Breast-fed Neonate
Letter to the editor
The Pediatric Infectious Disease Journal
Copyright © 2014 by Lippincott Williams & Wilkins
PIDJ 213-1007
Pediatr Infect Dis J
Lippincott Williams & Wilkins
Hagerstown, MD
Copyright © 2014 by Lippincott Williams & Wilkins
ISSN: 0891-3668/14/3306-0668
DOI: 10.1097/INF.0000000000000258
The authors have no funding or conflicts of interest
to disclose.
Supplemental digital content is available for this arti-
cle. Direct URL citations appear in the printed
text and are provided in the HTML and PDF
versions of this article on the journal’s website
Ocular Molluscum 
Contagiosum Atypical 
Clinical Presentation
To the Editors:
Empyema necessitatis is a rare complica-
tion of pleural space disease in the pedi-
atric population. Here, we present a case of
a 4-week-old female neonate who developed
community-acquired methicillin-resistant
Staphylococcus aureus (CA-MRSA) associ-
ated empyema necessitatis and rib osteomy-
elitis as a result of exposure to a maternal
breast abscess via breast-feeding.
A 4-week-old girl presented to
an outside emergency department with
a 5-day history of a gradually enlarging
right-sided chest and back mass. Approxi-
mately 2 weeks before presentation, she
had been admitted for neonatal fever and
received ampicillin and gentamicin. Work
up included negative blood, urine and cer-
ebrospinal fluid cultures and a normal chest
radiograph, and the patient was discharged
after 48 hours. During the following week,
the infant’s mother developed gradually
worsening pain and swelling in her breast.
On the day of the infant’s presentation with
the chest mass, her mother was admitted
The Pediatric Infectious Disease Journal
Pediatr Infect Dis J
Lippincott Williams & Wilkins
Hagerstown, MD