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Ultrastructural Evidence for Its Presence in Skin Adjacent to Clinical Lesions in Patients Infected With Human Immunodeficiency Virus Type 1

LTC Kathleen J. Smith, MC; CDR Henry G. Skelton III, MC; LCDR Josef Yeager, MC; COL William D. James, MC; Kenneth F. Wagner, DO

Arch Dermatol. 1992;128(2):223-227.

Abstract
• Background and Design.—
Molluscum contagiosum in acquired immunodeficiency disease, although not life threatening, is often a marker of late-stage disease and may lead to disfiguring cutaneous lesions. Although most current therapy results in at least temporary clearing of individual lesions, lesions frequently recur and new lesions arise. Examination of hematoxylin-eosin-stained histologic sections in two patients showed changes suggestive of viral infection in the epidermis 0.5 cm and 1 cm lateral to obvious clinical lesions. These areas were clinically free of any lesions. Both routine histopathologic examination and ultrastructural examination were performed in two patients infected with human immunodeficiency virus type 1 (HIV-1) and three non-HIV-1-infected patients.

Results.—
All patients showed histologic changes diagnostic of molluscum contagiosum. In addition, the sections from HIV-1-infected patients showed areas of acanthosis, hyperkeratosis, and nuclear atypia. Electron microscopy of these areas revealed rare viral organisms in these areas. Similar acanthotic, hyperkeratotic areas were not seen in the biopsy specimens from the non-HIV-1-infected patients and no viral particles were found in the epidermis around the lesions.

Conclusion.—
Viral structures consistent with molluscum contagiosum are present within the clinically normal epidermis around lesions of molluscum contagiosum in some HIV-1-infected patients. This may explain the large number of lesions seen in these patients and the difficulty in controlling the spread and recurrence of molluscum contagiosum in HIV-1-infected patients.

(Arch Dermatol. 1992;128:223-227)

Author Affiliations
USA; USN; USN; USA; Military Medical Consortium for Applied Retroviral Research

From the Department of Dermatopathology (Dr Skelton), Armed Forces Institute of Pathology; Department of Dermatology, Walter Reed Army Medical Center (Dr James); Department of Dermatology, National Naval Medical Center (Dr Yeager); Walter Reed Army Institute of Research (Dr Smith); and the Henry M Jackson Foundation (Dr Wagner), Washington, DC.

Footnotes
Accepted for publication July 31, 1991.

Reprint requests to Department of Dermatopathology, Armed Forces Institute of Pathology, Washington, DC 20306 (Dr Skelton).

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