Molluscum contagiosum in multiple epidermal cysts in an immunocompetent patient.

M contagiosum virus (MCV) infection occurring in an epidermal cyst (EC) is a very rare condition and only a few cases were reported in children and adults.1-3 However, MCV in multiple small epidermal cysts (ECs) was not previously described. Therefore, this unusual case of molluscum infestation occurring in multiple ECs was presented. A 20-year-old female was evaluated with an asymptomatic, firm, flesh-coloured nodular lesion on temporal region of 6 months’ duration. On dermatological examination, neither scale, punctum, or erosion on the surface of the lesion, nor similar lesions elsewhere were observed. She gave no history of previous medication, trauma or illness. A total excisional biopsy of the lesion was performed. Histopathological examination revealed hyperplastic inverted squamous epithelium forming cup shape (Figure 1A right) and 3 small cysts lining epithelium filled with lamellar keratinous material (Figures 1A left, & 1B). Cytoplasmic granular eosinophilic inclusions and molluscum bodies in keratinous surface were observed (Figure 1C). The wall of the cyst was lined by squamous epithelium, including a granular layer with keratohyaline granules. Numerous molluscum bodies were seen in the spinous, granular, and horny layers of the cyst wall (Figures 1D & 1E). The diagnosis of molluscum contagiosum was confirmed with clinical and histopathological findings. Results of the basic metabolic profile, complete blood count and anti-human immunodeficiency virus (HIV) antibody were within normal ranges. No recurrence of the lesion was noted during follow up. Molluscum contagiosum is a common skin infection produced by a double-stranded deoxyribonucleic acid (DNA) virus of poxvirus family. Four major subtypes of MCV were defined from MCV-1 to MCV-4. Lesions of MCV are characterized by multiple, umbilicated papules in children, sexually active adults, and in some immunosuppressed patients. Even though the disease is selflimiting, it may take several years for lesions to disappear.4 While various benign or malign conditions arising in cutaneous ECs were rarely observed, histopathological evaluation of all lesions clinically diagnosed as EC was suggested, especially in patients under local or systemic immunosuppressive treatment.3 Moreover, patients with advanced HIV disease were reported to have an increased incidence of MCV infection and a few cases of MCV in an EC in a HIV patient were described.2 Nevertheless, anti-HIV antibody was negative, and there was not any sign of immunosuppression in the presented case. The MCV infection might be suggested to play a role in the development of some of the benign epithelial cystic lesions, in which the cytopathic features of this virus were identified.5 The reason for the presence of MCV in EC was Clinical Note