Evolution of HIV-1-related conjunctival molluscum contagiosum under HAART: report of a bilaterally manifesting case and literature review

Purpose To present a rare case of bilateral conjunctival molluscum contagiosum (MC) in an HIV-positive individual who had unilateral lesion excision before induction of highly active antiretroviral therapy (HAART), and to discuss the pathophysiological consequences of immune restoration. Methods Case report: A 40-year-old male Caucasian presented with atypical, bilateral lesions of the limbal conjunctiva due to MC. Before the induction of HAART, nodules in the left eye were excised whilst the single lesion in the right eye was left untouched. Results The clinical diagnosis of conjunctival MC was confirmed histopathologically. Six months after the induction of HAART, the untouched lesion (right eye) had regressed and there was pronounced local injection of the conjunctiva. MC lesions did not recur after excision (left eye), and signs of inflammation were absent. Conclusion Conjunctival MC is rare and associated with immune deficiency. To the best of our knowledge, the presented case is the first reported instance of bilateral, multi-lesional MC of the conjunctiva in an HIV-positive patient undergoing HAART. Attention must be paid to the possible complications associated with the restoration of immunocompetence.