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Molluscum vs Cryptococcosis — SCE Infectious Diseases MCQ

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ModerateHIV MedicineMolluscum vs CryptococcosisSCE Infectious Diseases

A 35-year-old woman with well-controlled HIV presents with painless papular skin lesions on her face that have a characteristic 'pearly' appearance with central umbilication. Her CD4 is 620 and VL <50 on ART. These lesions are clinically indistinguishable from those seen in disseminated cryptococcosis. What simple investigation distinguishes molluscum from cryptococcosis?

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Correct answer: E — Skin biopsy — molluscum shows Henderson-Patterson bodies (intracytoplasmic inclusions); Cryptococcus shows encapsulated yeasts on India ink or mucicarmine stain

Umbilicated papular lesions in HIV can represent either molluscum contagiosum or disseminated cutaneous cryptococcosis — they are clinically identical. Skin biopsy with histology is the definitive distinguishing investigation. Molluscum shows Henderson-Patterson bodies (large eosinophilic intracytoplasmic inclusions in keratinocytes). Cryptococcus shows encapsulated yeasts on mucicarmine stain or India ink. Serum CrAg supports the diagnosis of cryptococcosis but biopsy provides definitive tissue diagnosis. At this CD4, disseminated cryptococcosis is very unlikely but the principle is important.

Reference: BHIVA 2022 – Dermatological manifestations of HIV