CASE 3

CASE 3
40

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:
(pearly)
(central umbilication)

 2 :

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Molluscum contagiosum
Smooth , dome-shaped ,
pearly , central umblilication

Common wart

(Cauliflower)

 2 excisional biopsy

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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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).
Lesions are self-limiting
May take 6 months to 5 years
for lesion disappearance
in the absence of therapeutic intervention.

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Pathogenesis
A localized mass
of hypertrophied epidermis,
which extends down
into the dermis
without injury
to the basement membrane.

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Pathogenesis
Large 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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Bilateral perihilar interstitial infiltration
bronchioloalveolar lavage GMS

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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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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Antibiotics are primarily recommended for treatment of mild,

moderate, or severe PJP.

Trimethoprim-sulfamethoxazole (TMP-SMX)
has been shown to be as effective as intravenous pentamidine.
Corticosteroids are used as adjunctive initial therapy only in
patients with HIV infection who have severe PJP.

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Preventive measures
(eg, smoking cessation and chemoprophylaxis) can play an
important role in disease management.