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Received: 7 October 2019    Revised: 27 November 2019    Accepted: 9 December 2019
DOI: 10.1111/tid.13235
LETTER TO THE EDITOR
Molluscum contagiosum mimicking condyloma acuminata in a
renal transplant patient: A unique presentation
To the Editor,
Molluscum contagiosum (MC) is a benign viral skin infection char-
acterized by single or multiple umbilicated papulonodules on the
face, arms, legs, and anogenital region; it is caused by the MC
virus.
We describe the case of a 36-year-old man with agminated
papulonodules in the pubic area, which had developed over
1 month. A clinical examination revealed clustered erythematous,
dome-shaped, non-umbilicated papulonodules ranging in size
from 0.5 to 1 cm (Figure 1A). He had undergone renal transplanta-
tion 18 years ago and was receiving immunosuppressive therapy
with cyclosporin on presentation. Serologic (laboratory) tests for
human immunodeficiency virus (HIV) infection, syphilis, and hep-
atitis B/C were negative. After the clinical diagnosis of condyloma
acuminata was made, skin biopsy and the human papillomavirus
(A)
(B)
F I G U R E 1   A, Clustered erythematous, dome-shaped, and non-
umbilicated papules in the pubic area. B, Acanthotic epidermis and
many epidermal cells with eosinophilic intracytoplasmic inclusions
(molluscum bodies) (hematoxylin and eosin staining, ×100)
Transpl Infect Dis. 2020;22:e13235. wileyonlinelibrary.com/journal/tid |
https://doi.org/10.1111/tid.13235
(HPV) test were performed, and the histopathologic results re-
vealed acanthotic epidermis with round-oval eosinophilic intra-
cytoplasmic inclusions increasing in size toward the upper layers;
skin biopsy was negative for all HPV probes tested (Figure 1B).
These histologic findings led to the diagnosis of MC. The patient
was treated with topical 5% imiquimod cream for 4 months and
showed a partial response.
Molluscum lesions consist of 1-5-mm pearly, white, or skin-col-
ored round papules with an umbilicated center; these papules vary
in number. The morphologic variants of MC include giant lesions
larger than 5 mm, eczematous lesions, and folliculocentric lesions
with secondary abscess formation. Sometimes, the lesions may
form clusters composed of many small lesions (agminate or giant
form) or present in an atypical location or configuration and with
varying size or number, making the diagnosis relatively unclear,
such as in the present case. These unusual clinical presentations
can usually be seen in immunodeficient patients, such as those
with HIV infection, as well as in patients who underwent steroid
and immunosuppressive therapy and those with leukemias.1 Organ
transplant recipients have an increased risk of viral skin infections
due to the immunosuppressive drugs used to ensure long-term
graft survival. One study reported that the prevalence of warts
was up to 50% in renal transplant recipients with graft survival
>5 years. 2 Furthermore, MC has been reported in up to 7% of
organ transplant recipients and is the fourth most common skin
infection after warts, tinea versicolor, and herpes simplex/zos-
ter. 3 MC may occur in the severe or persistent form, and it may be
refractory to conventional destructive or ablative approaches in
the immunocompromised population. Intravenous or intralesional
interferon alpha, intravenous or topical cidofovir, and imiquimod
have recently been reported for the treatment of MC in organ
transplant recipients. Two cases of multiple giant MC with papules
larger than 1 cm on the face and axilla have been reported in renal
transplant recipients.4,5 To our knowledge, the present case is the
only report of MC in the genital area mimicking condyloma acumi-
nata in an immunocompromised patient. Through this case report,
we emphasize that physicians can provide proper treatment by
performing early skin biopsy and identifying the viral etiology in
the differential diagnosis of verrucous lesions in immunocompro-
mised patients.
K E Y WO R D S
condyloma acuminate, molluscum contagiosum
© 2020 John Wiley & Sons A/S.     1 of 2
Published by John Wiley & Sons Ltd
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2 of 2       LETTER TO THE EDITOR

C O N FL I C T S O F I N T E R E S T Correspondence
None. Kihyuk Shin, Department of Dermatology, School of
Medicine, Pusan National University, 305 Guduk-ro, Seo-gu,
AU T H O R C O N T R I B U T I O N S Busan 602-739, Korea.
All authors have contributed significantly to the work presented and Email: teriakiller@hanmail.net
creation of the manuscript. All authors have reviewed and approved
the manuscript submission. ORCID
Dae-Lyong Ha  https://orcid.org/0000-0002-2268-4795
Dae-Lyong Ha1,2
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