Umbilicated papules in an immunocompromised patient

A 68-year-old male with HIV (CD4 count: 167 cells/mm³) presented with multiple umbilicated papules on the face and chest and a giant pedunculated nodule on the forehead, persisting for six months. Differential diagnoses included molluscum contagiosum, histoplasmosis, and cryptococcosis for the papules, and giant molluscum contagiosum or squamous cell carcinoma for the nodule. Histopathology revealed epidermal hyperplasia with Henderson Patterson bodies, confirming molluscum contagiosum. Fungal stains, cultures, and antigen tests for cryptococcosis and histoplasmosis were negative. The patient was started on highly active antiretroviral therapy (HAART) for immune reconstitution. This case underscores the importance of histopathology in differentiating molluscum contagiosum from opportunistic infections in immunocompromised patients and highlights HAART as a key therapeutic intervention.