Inflamed pedunculated giant molluscum contagiosum of eyelid in an immunocompetent child

Abstract

Molluscum contagiosum (MC) is a skin infection caused by a member of the Poxvirus family. It typically affects young or immunocompromised individuals.[1]. Lesions are localised localized on the face, arms, legs, and anogenital region. Typically, it presents as single or multiple umbilicated papules or nodules on the skin and eyelid margin and conjunctiva.[2] There are very few reports of giant molluscum presenting as an inflammatory lesion in an immunocompetent patient. Here, we are presenting a case of solitary giant MCmolluscum contagiosum presenting like an inflamed pedunculated mass of eyelid in an immunocompetent child.
A one 1½and half -year- old immunocompetent child presented with an inflamed large umbilicated lesion in upper eyelid which was excised in toto. Excision revealed a gyriform lesion and histopathologic confirmation was done.

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Brief Communications
130 Journal of Clinical Ophthalmology and Research - Volume 9 - Issue 3 - September-December 2021
causing devastating vision‑threatening complications with
features like that of a frankly leaking bleb. Metaplastic
changes and abnormality of the gap junctions may explain the
underlying mechanism of the dysfunctioning bleb, despite a
continuous epithelial lining or intact bleb wall, and a diffuse
clinical appearance of the bleb.
Declaration of patient consent
The authors certify that they have obtained all appropriate
patient consent forms. In the form the patient(s) has/have
given his/her/their consent for his/her/their images and other
clinical information to be reported in the journal. The patients
understand that their names and initial s will not be published
and due efforts will be made to conceal their identity, but
anonymity cannot be guaranteed.
Acknowledgement
Dalmia Ocular Pathology services at LV Prasad Eye Institute,
MTC campus, Patia, Bhubaneswar.
Financial support and sponsorship
Nil.
Conicts of interest
There are no conflicts of interest.
References
1. Sinnreich Z, Barishak R, Stein R. Leaking ltering blebs. Am J
Ophthalmol 1978;86:345‑9.
2. Nuyts RM, Felten PC, Pels E, Langerhorst CT, Geijssen HC,
Grossniklaus HE, et al. Histopathologic eects of mitomycin
C after trabeculectomy in human glaucomatous eyes with
persistent hypotony. Am J Ophthalmol 1994;118:225‑37.
3. Addicks EM, Quigley HA, Green WR, Robin AL. Histologic
characteristics of ltering blebs in glaucomatous eyes. Arch
Ophthalmol 1983;101:795‑8.
4. Shields MB, Scroggs MW, Sloop CM, Simmons RB. Clinical
and histopathologic observations concerning hypotony
after trabeculectomy with adjunctive mitomycin C. Am J
Ophthalmol 1993;116673‑83.
5. Mie H, Brunner R, Addicks K, Krieglstein GK. Histopathology
of an avascular filtering bleb after trabeculectomy with
mitomycin‑C. J Glaucoma 1993;2:266‑70.
6. Cillino S, Casuccio A, Di Pace F, Cagini C, Ferraro LL, Cillino G.
Biodegradable collagen matrix implant versus mitomycin‑C
in trabeculectomy: Five‑year follow‑up. BMC Ophthalmol
2016;16:24.
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www.jcor.in
DOI:
10.4103/jcor.jcor_24_20
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Department of Ophthalmology, Yenepoya Medical College, Mangalore,
Karnataka, India
Address for correspondence: Dr. Divyalakshmi Kaiyoor Surya,
Department of Ophthalmology, Yenepoya Medical College,
Mangalore ‑ 575 018, Karnataka, India. E‑mail: divyalakshmikns2002@
yahoo.com
Submission: 21.03.2020; Decision: 08.06.2021;
Acceptance: 16.06.2021; Web Publication: 27.09.2021
Inamed pedunculated giant molluscum contagiosum of eyelid in an
immunocompetent child
Divyalakshmi Kaiyoor Surya, Cynthia Arunachalam
Cite this article as: Surya DK, Arunachalam C. Inamed pedunculated
giant molluscum contagiosum of eyelid in an immunocompetent child. J Clin
Ophthalmol Res 2021;9:130-2.
This is an open access journal, and articles are distributed under the terms of
the Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License,
which allows others to remix, tweak, and build upon the work non‑commercially,
as long as appropriate credit is given and the new creations are licensed under
the identical terms.
For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com
Molluscum contagiosum (MC) is a skin infection caused by a member of the Poxvirus family. It typically aects
young or immunocompromised individuals.[1]. Lesions are localised localized on the face, arms, legs, and
anogenital region. Typically, it presents as single or multiple umbilicated papules or nodules on the skin and eyelid
margin and conjunctiva.[2] There are very few reports of giant molluscum presenting as an inammatory lesion in an
immunocompetent patient. Here, we are presenting a case of solitary giant MCmolluscum contagiosum presenting
like an inamed pedunculated mass of eyelid in an immunocompetent child.
A one 1½and half ‑year‑ old immunocompetent child presented with an inamed large umbilicated lesion in upper
eyelid which was excised in toto. Excision revealed a gyriform lesion and histopathologic conrmation was done.
Key words: Giant molluscum, immunocompetent, molluscum contagiosum
Molluscum contagiosum (MC) is a skin infection caused by
a member of the Poxvirus family. It typically affects young
or immunocompromised individuals.[1] Lesions are localized
on the face, arms, legs, and anogenital region. Typically,
it presents as single or multiple umbilicated papules or
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Brief Communications
Journal of Clinical Ophthalmology and Research - Volume 9 - Issue 3 - September-December 2021 131
nodules on the skin and eyelid margin and conjunctiva.[2]
There are very few reports of giant molluscum presenting
as an inflammatory lesion in an immunocompetent
patient. Here, we are presenting a case of solitary giant MC
presenting like an inflamed pedunculated mass of eyelid in
an immunocompetent child.
Case Report
A 1 ½‑year‑old child presented with mass of left eye upper
lid of 3‑month duration with a history of similar swellings on
the face. Lid swelling showed a progressive growth in size with
recurrent respiratory infections. A history of similar lesions in
the siblings was also noted.
On examination, 10 mm × 10 mm, soft pedunculated
lesion with umbilicated pouting surface was noted on the
medial one‑third of the left upper lid, involving the anterior
lid margin sparing the lash margin, lacrimal punctum,
and canaliculus. Crusting and scarring of the apex with
excoriation of the surrounding skin were seen. The skin over
the swelling was mobile except near the umbilicated surface.
Increased vascularity was seen with no evidence of bleeding or
abnormal discharge [Figure 1]. Mechanical ptosis was noted.
Rest of the ocular examination was within normal limits.
Laboratory investigations revealed hemoglobin of
14.5 gm%, total count of 11600/mm3, with lymphocyte count
of 32%, platelets 2.2 lakhs/mm3, serum creatinine 0.7 mg/dl;
liver function test was in normal range. Peripheral smear did
not show any evidence of atypical cells. Random blood sugar
was 67 mg%. Serological investigations including hepatitis
B and human immunodeficiency virus were negative. Thus
common causes of immunodeficiency were ruled out.
Incision was made along the lid crease. Blunt dissection
of the subcutaneous tissue was done. A well‑encapsulated
gyriform‑shaped lesion was excised in toto [Figures 2 and 3]
and tissue sent for histopathology. Primary closure of skin was
done. H and E staining of the specimen showed acanthotic
epidermis lined by stratified squamous epithelium, invaginated
into lobules with homogenous eosinophilic cytoplasmic
Figure 1: Solitary pedunculated giant molluscum of left eye upper lid Figure 2: Complete excision
Figure 3: Complete excision followed by primary closure Figure 4: HPE showing eosinophilic cytoplasmic inclusion bodies
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Brief Communications
132 Journal of Clinical Ophthalmology and Research - Volume 9 - Issue 3 - September-December 2021
Fungal choroidal abscess in a case of aggressive retinopathy of prematurity
Taranpreet Kaur, Vipan Kumar Vig1, Inderjit Kaur, Sunita Arora2
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Website:
www.jcor.in
DOI:
10.4103/jcor.jcor_213_20
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Fungal choroidal abscesses are rarely reported entities on routine retinopathy of prematurity screenings done on
neonates. With the increasing use of broad‑spectrum intravenous antibiotics on preterm neonates during their stay in
neonatal intensive care unit who are already immunodecient, we hereby bring this case into notice so as to keep fungal
etiologies as a close dierential in comparison to bacterial choroidal abscesses, the latter being more common in the
older age group. The late diagnosis of fungal choroidal abscess and the lack of systemic treatment for the same could
possibly lead to acquired hydrocephalus and other systemic complications.
Key words: Aggressive posterior retinopathy of prematurity, candidemia, fungal choroidal abscess, hydrocephalus,
neonatal intensive care unit, neonatal sepsis, retinopathy of prematurity, ventriculoperitoneal shunt
Fungi are a relatively uncommon cause of choroidal
abscess in neonates and early infancy. They are usually
Departments of Ophthalmology and 2Paediatrics, Sri Guru Ram Das
Institute of Medical Sciences and Research, 1Sardar Bahadur Dr Sohan
Singh Eye Hospital, Amritsar, Punjab, India
Address for correspondence: Dr. Taranpreet Kaur, Department of
Ophthalmology, Sri Guru Ram Das Institute of Medical Sciences and
Research, Vallah, Amritsar, Punjab, India. E‑mail: taran1207mehar@
gmail.com
Submission: 29.09.2020; Decision: 16.02.2021;
Acceptance: 03.03.2021; Web Publication: 27.09.2021
Cite this article as: Kaur T, Vig VK, Kaur I, Arora S. Fungal choroidal abscess
in a case of aggressive retinopathy of prematurity. J Clin Ophthalmol Res
2021;9:132-6.
This is an open access journal, and articles are distributed under the terms of
the Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License,
which allows others to remix, tweak, and build upon the work non‑commercially,
as long as appropriate credit is given and the new creations are licensed under
the identical terms.
For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com
associated with predisposing factors such as prematurity,
low birth weight, use of broad‑spectrum antibiotics, and a
prolonged stay in the neonatal intensive care unit (NICU).
inclusion bodies [Figure 4], confirming the diagnosis of MC.
No recurrence of lesion was noted even at 3‑month follow‑up.
Discussion
MC is an innocuous condition which spreads by fomites or
casual contact or by sexual route.[2] Typically, it presents as an
umbilicated papule or a nodule on the face. Atypical lesions
with dimensions of 1 cm2 or more are referred to as giant
molluscum, seen usually in immunocompromised individuals.[2]
There are only a few case reports of giant molluscum involving
the eyelids in immunocompetent individuals.[3,4] It mimics
a wide variety of other conditions such as sebaceous cyst,
squamous papilloma, pyogenic granuloma, keratoacanthoma.
Ornek et al. have reported a 5‑year‑old immunocompetent child
with giant molluscum presenting as a preseptal cellulitis[5]
unlike our child who had an inflamed swelling with no evidence
of preseptal cellulitis. Complete excision with histopathological
examination will confirm the diagnosis.
Conclusion
Solitary giant MC can present like an inflamed
pedunculated lesion even in immunocompetent children.
Differential diagnosis includes pyogenic granuloma,
keratoacanthoma, squamous papilloma. Confirmation can be
done by demonstration of eosinophilic inclusion bodies on
histopathological examination. Complete excision should be
done to prevent recurrences.
Declaration of patient consent
The authors certify that they have obtained all appropriate
patient consent forms. In the form the patient(s) has/have
given his/her/their consent for his/her/their images and other
clinical information to be reported in the journal. The patients
understand that their names and initial s will not be published
and due efforts will be made to conceal their identity, but
anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conicts of interest
There are no conflicts of interest.
References
1. Lowy DR. Fitzpatrick’s Dermatology in General Medicine.
Molluscum Contagiosum. 6th ed. New York: McGraw‑Hill; 2003.
p. 114‑7.
2. Vardhan P, Goel S, Goyal G, Kumar N. Solitary giant molluscum
contagiosum presenting as lid tumor in an immunocompetent
child. Indian J Ophthalmol 2010;58:236‑8.
3. Pandhi D, Singhal A. Giant molluscum contagiosum. Indian Pediatr
2005;42:488‑9.
4. Kumar P, Chatura KR, Kumar VJ, Haravi RM, Chandrasekhar HR.
Giant molluscum contagiosum in an infant. Indian J Dermatol
Venereol Leprol 1999;65:290‑1.
5. Örnek K, Onaran Z, Koçak M. Giant eyelid molluscum contagiosum
presenting as preseptal cellulitis. J Paediatr Child Health
2014;50:1036.
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