A mistaken diagnosis of Molluscum contagiosum in a HIV-positive patient in rural South Africa

Abstract

A 25-year-old gentleman presented with multiple small ulcerations and papules covering a large portion of his face and neck, associated with general malaise. He was HIV seropositive with a total CD4 count of 78 cells/μl. A diagnosis of Molluscum contagiosum was made and the patient discharged. He re-presented 3 weeks later with a 2-day history of progressively worsening headache associated with photophobia and diarrhoea. The generalised skin eruption had worsened, now involving his torso and upper limbs. Cerebrospinal fluid examination was highly positive for cryptococcal antigens and the patient was started on amphotericin B. Skin biopsy con firmed cutaneous Cryptococcus neoformans. After 4 days, the headache and photophobia resolved. A mild improvement in his skin was seen after completing 14 days of treatment. He was discharged with lifelong fluconazole therapy. Copyright 2012 BMJ Publishing Group. All rights reserved.