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CASE 3

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CASE 340

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1 :

(pearly) (central umbilication)

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2 :

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3

Molluscum contagiosum Smooth , dome-shaped ,

pearly , central umblilication

Common wart

(Cauliflower)

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2 excisional biopsy

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4.

Verrucous epidermal hyperplasia

contains Molluscum bodies

a large (up to 35 m),

ellipsoid, homogeneous, cytoplasmic

inclusion in cells

of the stratum granulosum

and the stratum corneum

Molluscum contagiosum ()

Molluscum contagiosum virus

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5

Genital molluscum contagiosum Epidermal viral infection Genus Mollusci pox virus 3 subtypes

Transmission

- Direct bodily contact (eg, sexual activity)

- Fomites (eg, underwear)

14- to 50-day incubation period

Clinical presentation : White, pink, or flesh-colored, umbilicated, raised

papules (1-5 mm in diameter) or nodules (6-10 mm in diameter).

Lesionsare self-limiting

May take 6 months to 5 yearsfor lesion disappearance

in the absence of therapeutic intervention.

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5

Pathogenesis

Alocalized mass

of hypertrophied epidermis,

which extends downinto the dermis

without injury

to the basement membrane.

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5

PathogenesisLarge hyaline acidophilic granular masses,

known as molluscum bodies,

filling the cytoplasm

and pushing the nucleus

to the edge of the cell.

The center of the lesion

consists of degenerating epidermal cells

with inclusion bodies and keratin.

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6 ..

Bilateral perihilar interstitial infiltration

bronchioloalveolar lavage GMS

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6 Lung biopsy : The cysts are

round, oval or flat bodies of

approx.4-5 m in diameter.

Gomori's methenamine silver stain (GMS).

intracystic body cyst

cyst alveoli

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7

Pneumocystis carinii pneumonia

CD4+ 40 cell/microliter

trophic form

alveoli

hypoxia ,

impaired diffusing capacity ,

change in total lung capacity

and vital capacity

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8

Antibioticsare primarily recommended for treatment of mild,

moderate, or severe PJP.

Trimethoprim-sulfamethoxazole (TMP-SMX)

has been shown to be as effective as intravenous pentamidine.

Corticosteroidsare used as adjunctive initial therapy only in

patients with HIV infection who have severe PJP.

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