Recalcitrant giant molluscum contagiosum in a patient with advanced HIV disease - eradication of disease with paclitaxel.

Molluscum contagiosum is a poxvirus skin infection that is self-limited and harmless, usually causing numerous single, umbilicated papules in immunocompetent people. However, a patient with immunodeficiency such as that associated with HIV disease may present with giant, widespread, and chronic lesions, for which no single intervention has been shown to be convincingly effective for curative treatment. Poxviruses utilize the microtubule cytoskeleton within the cytoplasm of eukaryotic cells for movement into the human host cell during the establishment of infection and for facilitating the continued spread of virus infection. Paclitaxel, a chemotherapeutic drug used for treatment of cancer, targets the host cell’s microtubule cytoskeleton, resulting in apoptotic programmed cell death and potential disruption of the molluscum contagiosum virus (MCV) lifecycle. This, in turn, potentially leads to decreased viral replication and ultimately decreased burden of disease. We report here an unusual case of giant molluscum contagiosum lesions in a person with AIDS, refractory to conventional therapy but responsive to treatment with paclitaxel. No similar case appears to have been described previously.