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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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