[PDF][PDF] Efficacy of cidofovir in the treatment of recalcitrant molluscum contagiosum in an AIDS patient

V Ibarra, JR Blanco, JA Oteo… - Acta Dermato …, 2000 - medicaljournalssweden.se
V Ibarra, JR Blanco, JA Oteo, L Rosel
Acta Dermato-Venereologica, 2000medicaljournalssweden.se
Sir, Molluscum contagiosum is a cutaneous skin lesion exclusive to humans, caused by
molluscum contagiosum virus (MCV), a DNA virus of the poxvirus family. Among HIV
patients, the prevalence of MCV is from 5 to 18%(1). This illness is usually limited and
characterized by small, nodule-shaped lesions, indolent and umbilicated, and it can affect
every part of the body except the palms and soles (1). The treatment is often unsatisfactory
and there is no proven, specific antiviral therapy. We describe here a patient with recalcitrant …
Sir, Molluscum contagiosum is a cutaneous skin lesion exclusive to humans, caused by molluscum contagiosum virus (MCV), a DNA virus of the poxvirus family. Among HIV patients, the prevalence of MCV is from 5 to 18%(1). This illness is usually limited and characterized by small, nodule-shaped lesions, indolent and umbilicated, and it can affect every part of the body except the palms and soles (1). The treatment is often unsatisfactory and there is no proven, specific antiviral therapy. We describe here a patient with recalcitrant molluscum contagiosum who was resolved with intravenous cidofovir.
In November 1996, a 32-year-old man with AIDS (CDC stage C3) and previous history of recurrent pneumonia and pulmonary tuberculosis came to our service because of the appearance of rounded, umbilicated papules and plaques on his face, which subsequently grew in number and size (Fig. 1). A biopsy specimen was examined, and confirmed the diagnosis of MCV. CD4 cell count was 76 cell/mm3 and his HIV RNA level was 427,764 copies per ml. From May 1996 to June 1997 he was treated with zidovudine (ZDV) plus zalcitabine (DDC), and from then to November 1997 with ZDV plus lamivudine (3TC) plus saquinavir (SQV). He also received prophylactic therapy against Pneumocystis carinii with trimethoprimÐsulfamethoxazole 3 days a week. The patient had never followed the treatment properly because he usually stopped taking the prescribe medications. Finally all treatment (antiretroviral and prophylaxis) was stopped definitively in November 1997, as this was decided by the patient. His lesions were treated in several occasions without success with curettage and podophyllin. In February 1998, he presented with extensive MCV lesions covering more than 60% of his face. This produced in our patient a severe depression, even with a suicide attempt, beginning treatment with paroxetine. Treatment with cidofovir (5 mg/kg once per week followed by 5 mg/kg once every 2 weeks for maintenance therapy) and probenecid (2 g, 3 h before the administration of cidofovir, and 1 g, 2 and 8 h later) was initiated in spite of not having a clear indication due to the
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